
Class _JE^_iXl 
CoiwightN" ' 

CQEmiGHT DEMSm 



V 



EXCESSIVE VENERY 



MASTURBATION 

CONTINENCE 



THE ETIOLOGY, PATHOLOGY AND TREATMENT OF THE 

DISEASES RESULTING FROM VENEREAL EXCESSES, 

MASTURBATION AND CONTINENCE. 



BY 
JOSEPH W. HOWE, M. D., 

Author of " Emergencies," " The Breath," " Winter Homes for Invalids," Late Professoc 
of Clinical Surgery in Bellevue Hospital Medical College, Fellow of the New Yo/K 
Academy of Medicine, Member of the New York County Medical, Patho- 
logical and Surgical Societies, Visiting Surgeon to Charity and St. 
Francis Hospitals, Consulting Physician to the Hospital 
for the Treatment of Diseases of Mouth and 
Throat, etc. 








NEW YOEK : 
E. B. TREAT, T71 Broadway. 

1887. Price, $2 75. 






COPYRIGHT, 1887. 

By 
E. B. TREAT, N. Y. 



^P? 



PREFACE. 

This volume contains the substance of a course of lectures 
delivered in the Medical Department of the University of New- 
York, on the Results of Excessive Venery, Masturbation and 
Continence. In addition to the results of my own experience 
obtained in hospital and private practice, I have added the 
peculiar methods of treatment employed by various authorities 
in Europe and America, thus making the volume complete as a 
book of reference for the student and practitioner of medicine. 

38 W. 24th St., New York, J. W. H 



TABLE OF CONTENTS. 

CHAPTER I. 

GENERAL CONSIDERATIONS . 

Ignorance of Sexual Hygiene and its results — Should Laws Regulating 
Sexual Functions be taught before years of maturity are reached — Ignorance 
of function in the married state, and its results — Ignorance as a cause of 
sexual excess and Masturbation — Cases of Phthisis, from parental excess — 
The physician as a teacher of Sexual Hygiene— When and How to teach — 
Lessons to be regulated by the mental and physical peculiarities of the 
child— Fear as a necessary educational agent — A clergyman's idea of what 
should be taught of sexual physiology and Hygiene — The schoolmaster 
as a guardian of school morals. ^7 

CHAPTER II. 

THE GENITAL APPARATUS. 

Anatomy and functions of portions of the male and female genital organs — 
Erectile Tissues — Peculiarities of erectile tissues — Blood supply of the 
erectile tissue of the penis — Buck's fascia — Structure of the corpora 
cavernosa and corpus spongiosum — Action of muscles attached to these 
organs — The glans Penis — Changes in the glans from Masturbation and 
Sexual Excess — Dorsal artery of the penis — Membranous urethra — 
Cowper's Gland — Character of its secretion — Prostatic Urethra — ^Veru 
Montanum — Prostatic Ducts — Ejaculatory Ducts — Morbid changes from 
Masturbation — Intimate structure of Prostate gland — Sphincter Muscle of 
the Neck of the Bladder 28 

CHAPTER III. 

THE SEMINAL FLUID AND THE MECHANISM OF ERECTION. 

Physiological properties of seminal fluid — Chemical composition of semen — 
Gross Appearances — Characters of Spermatozoa — Peculiar movements 
under the microscope — Chemical composition of spermatozoa — Various 
quantities formed and ejaculated — Secretion of Prostate and Cowper's 
Glands, as forming a part of the Seminal Fluid — Natural and morbid 
secretions that may be mistaken for semen — Muco-Purulent secretion 
in Prostatitis, Urethritis and Cystitis — Mixture r>{ mucus with epithelial 
cells — Chylous Urine— Distinguishing characteristics of each — Mechanism 
of erection — Nerve centers governing erection — Function of the cerebellum 
— Effects of removal of the organ — Clots and tumors in the cerebellum 
— Emissions produced by Shampooing the occiput — Location of the 
genito-spinal center — Sympathetic Nervous Influence — Analogy between 
the act of blushing and erection — Influence of the mind — Cases of partial 
erection 43 



Xll CONTENTS. / 

CHAPTER IV. 

DISEASES FROM EXCESS, ETC. 

What constitutes Spermatorrhoea ? — Opinions of Hippocrates, Celsus, 
Lallemand, Acton, Van Buren, Hamilton, Bartholow, McGraw, Gross, 
Post, Hutchinson, Morse, and others — ^Various causes of Spermatorrhoea 
and Impotence — Masturbation, Sexual excesses, Mental emotions. Conti- 
nence, Diseases of nerve centers. Diseases of Testicles and Penis, 
Congenital and acquired Malformations — Relative indulgence in the vice 
of masturbation by inhabitants of savage and civilized countries — 
Masturbation among animals — Age at which onanism is usually begun — 
Nurses as teachers of immorality — Dangers of intimate companionship — 
Influence of certain gymnastic exercises in developing masturbation — 
Varieties of exercises which should be prohibited — Cases in which swing- 
ing from poles and bars gives origin to the vice — Morbid changes in the 
genital organs caused by self-pollution — Constitutional changes from 
the same cause — Why seminal emissions occur when masturbation is dis- 
continued , 58 

CHAPTER V. 

RESULTS OF SEXUAL EXCESS AND MENTAL EMOTION. 

Sexual excess not so injurious as masturbation — Seminal losses not 
unhealthy when they occur from natural causes — Differences between 
local and general effects of sexual indulgence and masturbation — Excess as 
a cause of spermatorrhoea and impotence. Mental emotion as a cause of 
spermatorrhoea and impotence — Effects of emotion in hysteria. Simula- 
tion of mammitis, peritonitis, etc., by hysterical patients. Graham's bed 
for impotent patients — Impotence from fear, anxiety, bad odors, business 
troubles, bad temper, unusual surroundings, etc. — Interesting cases of 
Hammond's, Rouget's, and others 7^ 

CPIAPTER VI. 

DISEASES PRODUCED BY SEXUAL EXCESS AND MASTURBATION. 

Deterioration of the seminal fluid as a cause of pulmonary consumption- 
Changes in the healthy character of the secretions — Hereditary weakness, 
as a source of phthisis — Phthisis developed as a direct result of masturbation 
— Phthisis among young married persons — Erotic desires of consumptive 
Patients — Epilepsy — Connection with Onanism — Convulsive seizures 
during the orgasm — Changes in the nerve centers as a result of 
the disease — The center of sensation and voluntary motion — -Irritation of 
the tuber annulare — Causes of the convulsion — Termination of Epilepsy 
in insanity — Is insanity caused by sexual excess and masturbation — > 
Opinions of various authorities — Peculiar forms of insanity arising from 
these diseases — Nymphomania — Its causes — Characteristic cases — 
Mirriage as a means of cure — Amputation of the clitoris as employed by 
Baker Brown — Satyriasis — Curious manifestations of the disease — Treat- 
ment — Aspermatism, et : 92 



CONTENTS. XIH 



CHAPTER VII. 



<JISEASES OF THE GENITALS THAT ARISE FROM MASTURBATION AND 
SEXUAL EXCESS. 

Causes of Varicocele — General changes in the spermatic veins — Effects of the 
congestion and dilatation of the veins in the neighboring tissues — Mental 
depression caused by varicocele — Emissions and impotence as a result — 
Ligation of veins as a means of cure — Caustic applications —Galvano 
cautery, etc. — Amputation of the scrotum the only safe operation — Ecchy- 
mosis of scrotum — Neuralgia of the testicle — Irritable Testicle — 
Various methods of treatment — Neuralgia of the neck of the bladder — 
Treatment — Spasm of the muscles at the neck of the bladder as a cause 
of impotence. Congestion and inflammation of the Prostate gland — 
Treatment , . . - I2i 

CHAPTER VIII. 

DISEASES OF THE GENITALS ASSOCIATED WITH SPERMATORRHCEA 
AND IMPOTENCE. 

Accumulation of secretions under a tight prepuce as a cause of spermatorrhoea 
and impotence — Illustrative cases — Reflex irritation produced by Phimosis 
— Loss of voice from Phimosis cured by operation — Sayre's unique 
case — General treatment — Congestion of the prostate and inflammation of 
the prostate — Cases of spermatorrhoea and impotence produced by them — 
Impotence following the removal of calculi from the bladder by the lateral 
operation — Spermatorrhoea produced by Hypospadias and Epispadias— 
Curvature of the penis — Large penis — Prostatic calculi as a cause of 
spermatorrhoea 145 

CHAPTER IX. 

DISEASES THAT RESULT FROM SEXUAL EXCESS AND MASTURBATION. 

Cerebral Anaemia — Symptoms and course — Peculiarities of Cerebral Ansemia 
in connection with excess — Spasmodic contraction of voluntary muscles 
in connection with anaemia — Termination in white softening — Significance 
of loss of memory — Local paralysis — Effects of hemorrhage in the cere- 
bellum — Sclerosis of Nerve Fibres of Cerebellum — Hanging — Concussion 
of the spinal cord — Softening of spinal cord — Impotence from bui, 
stroke 174 

CHAPTER X. 

CONTINENCE. 

Fulfillment of function necessary to a healthy organization. Impairment 
of function as a result of disease or inaction — Results of suspending the 
functions of joints, muscles, eyes, etc. — Loss of s ght in animals secluded 
from the light — Changes in the genital organs from continence — Reasons 
why continence is likely to cause Spermatorrhoea and impotence — When 
continence produces these diseases, and marriage is not attainable, what 
advice should be given by the physician — Responsibility of the medical 
adviser — Moral aspect of the case — Views of clergymen on the subject, 
and their advice — Opinions of Acton and others 183 



XIV CONTENTS. 

CHAPTER XL 

CLASSIFICATION OF CASES FOR TREATMENT. 

Universal rules that are not universal — The danger of advising a single 
method of treatment for all cases of Spermatorrhoea and Impotence, 
without a special study of each case — Errors in treatment — Bromides as 
remedial agents. Their effects on the vascular and nervous systems — 
How they affect the digestive functions — The indiscriminate use of the drug 
productive of evil — Bromide of potassium as a cause of impotence — 
Cauterization of the prostatic portion of the Urethra — Its universal use in 
the treatment of spermatorrhoea — Why a classification of cases is 
necessary — Four varieties of spermatorrhoea — Peculiarities exhibited by 
the first class — Cases which are incurable — Second variety — Distinguishing 
features — Patients amenable to treatment — Peculiarities of third and fourth 
class of patients — Greater frequency of the milder forms of sperma- 
torrhoea 202 

CHAPTER XII. 

CONSTITUTIONAL TREATMENT OF SPERMATORRHCEA, IMPOTENCE AND 
AND ALLIED DISORDERS. 

General Debility a leading feature in the majority of cases — A special diet 
necessary for each patient — How to select a suitable diet — Cases in which 
the number of meals should be increased — Condition of the genital 
organs not to be considered in selecting food — Nutritious articles not to 
be set aside because they have a tendency to excite the genitals— Eggs, 
oysters, clams, raw beef, broths, gluten, cracked wheat, cream, milk, etc. 
Digestible salads — Zvlethod of preparing raw beef — Quantity of food for 
each meal — Incompatible mixtures of food in the stomach, and their 
effects — Rules for the selection of compatibles — Food that should be eaten 
— Food that should be excluded from the bill of fare — !Meat not to be 
eaten with milk — Other incompatibles — No lard or pork to be used in 
cooking — Mild wines permitted in the treatment 215 

CHAPTER XIII. 

CONSTITUTIONAL TREATMENT OF SPERMATORRHOEA, IMPOTENCE AND 
ALLIED DISORDERS. 

Condition of the bowels in spermatorrhoea — Scanty secretion — Diminished 
peristaltic action — Wliy the use of cathartics is contraindicated — Effect of 
constipation in increasing the number of seminal emissions — Semen 
evacuated at stool — Cases in which small doses of calomel may be 
employed — Action of Belladonna and Physostigma on the bowels — 
Injections of oil into the rectum — Cold water injections as a remedy for 
const'.Dation in spermatorrhoea — Local effects of the injections — Cold water 
bathing — ^\''arious methods of employing cold water in the treatment of 
spermatorrhoea and impotence — Cold sponge bath — Sitz bath^ — Shower 
bath — Rubbing bath — Sea bathing — Temperature of bath for weak and 
nervous patients — Local and general effects of the bath — Sleep and 
exercise 224 



Contents. xv 

CHAPTER XIV. 

treatment of Spermatorrhoea, Impotence, and allied disorders — Indications 
for the use of tonic medicines — Cases in which they are beneficial — 
Reasons for their discontinuance — Effects of Strychnia on the spinal cord 
— Combinations of Strychnia, Iron, Quinine and Glycerine — Tonics and 
nerve stimulants in nervous depression — Preparations to be employed when 
there is obstinate constipation — Palpitation of the heart, vertigo,etc. — 
Employment ot arsenic, iron, nux vomica, ergot, and quinia — Aphrodisiacs 
— Special indications for their employment. Classes of patients benefited 
by their use — When they should be discontinued — Peculiar effects of 
phosphorus on the nervous system and genital organs — Dangers connected 
with its administration — Compound phosphorus pills — Cantharides as an 
aphrodisiac — Best mode of administration — Combination of cannabis 
indica, ergot, nux vomica, sanguinaria, stillingia, water pepper, damiana 
— Homoeopathic remedies . 239 

CHAPTER XV. 

LOCAL TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 

Electricity the principal remedial agent in treatment of impotence — Effect 
of the induced and Faradic current — The continuous current — Cases 
illustrating the effects of electricity — Various Methods of Electrodes — 
Position of the patient — Urethral and rectal electrodes — Wire brush — 
Cauterization as a means of cure — Solid and liquid caustics — Lallemand's 
porte caustique — Precautionary measures to be adopted — Usual results 
of the operation — Caustic solutions safer — Instrument for introducing 
caustic solutions to the prostatic portion of the urethra — Acupuncture — 
Introduction of the needles — Regions in which the needles are inserted 
— Resulcs of Acupuncture, of astringents and anodyne applications — 
Medicated bougies— Spermatorrhoea rings, electrodes, rectal pessaries. 252 

CHAPTER XVI. 

TREATMENT OF SPERMATORRHCEA, IMPOTENCE, AND ALLIED DISORDERS. 

Methods of treatment used by Gross, Van Buren, Keyes, Hamilton, Post, 
Bartholow, Hutchinson, McGraw, Acton, Gant, Humphrey and 
others 269 



EXCESSIVE VENERY, MASTURBATION AND 
CONTINENCE. 



CHAPTER I. 

GENERAL CONSIDERATIONS. 

Ignorance of Sexual Hygiene and its results — Should laws regulating Sexual 
Functions be taught before years of maturity are reached — Ignorance ol 
Function in the Married State — Ignorance as a cause of Sexual Excesses 
and Masturbation — Instructive case — When and how to teach — Les- 
sons to be regulated by the Mental and Physical peculiarities of the child 
— Fear as a Necessary Educational agent — A Clergyman's idea as to what 
should be taught of Sexual Physiology and Hygiene — The Schoolmastei 
as a guardian of Morals. 

A knowledge of the sexual functions or of sexual hygiene is 
rarely considered to be a necessary part of our early educa- 
tion, and the value of such knowledge as promoting a healthy 
physical and mental condition is almost entirely overlooked. 
The age of puberty generally has passed, before the subject is 
introduced to the youthful mind even in the most casual way. 
Indeed there is scarcely a subject more completely ignored, 
although so much of the health and happiness of the race de- 
pends on it. The physician whose professional duties bring 
him a clearer insight into the private lives of his patients, be- 
yond the point where ordinary vision reaches, is about the only 
one who fully realizes the great necessity for the diffusion of such 
knowledge, and an education that will prevent those ignorant 
assaults on the genital organs which in time stunt the vital 
forces, and whether cured or not, leave their impress on the 
vital forces of the patients themselves, as well as on their un- 
fortunate offspring. Outside of the profession there are very 
few who ever get beneath the thin veneering to the rotten wood 



l8 GENERAL CONSIDERATIONS. 

below, and thus see the difference between the fictitious side of 
life, and the real or true life of suffering occasioned by igno- 
rance and bad habits, which might easily be avoided by a little 
care and wholesome advice given by parents, guardians or 
teachers, or perhaps best of all by the family physician, for he 
really is the person fitted by his position to give the necessary 
information in the way or manner that will carry with it its full 
weight of conviction, and compel a sensible enforcement of the 
laws which regulate sexual functions, and he can also briefly 
explain such points in the anatomy and physiology of the or- 
gans under consideration, as will facilitate the patient's efforts 
to do what is expected of him in an intelligent manner. But 
unfortunately, as things are, at the present day, the damage is 
usually done before there is a full realization of the means for 
preventing it. So dense, indeed, is the general ignorance on 
this important subject that it is not an uncommon event for 
men and women to enter the married state without any prelimi- 
nary knowledge whatever of the sexual relation. 

Married women, and men too, of much experience in other 
matters pertaining to the management of their physical natures, 
have informed me that when they entered the marriage state, 
they were totally unaware of the nature of the sexual relation, 
and that many days and nights were passed in the midst of 
curious sensations, doubts and fears and ridiculous perform- 
ances before the marriage was consummated. Neither did they 
comprehend the immediate or remote results of the new rela- 
tion. They knew not the difference between temperance and 
excess until disordered nerves and feeble bodies compelled 
them to seek advice from parents and friends who had passed 
through the same trials and with similar experiences. And in 
many instances this advice v/as sought too late for benefit. 



GENERAL CONSIDERATIONS. I9 

triends who were more versed in the matter than they were. 
This ignorance, of course, is more generally confined to women 
than to men, but there are enough instances among the latter, 
to make it a matter of surprise even to a physician who ought 
to be accustomed to surprises. As a case in point, the fol- 
lowing instance may afford food for reflection. In the summer 
of '79 while sojourning in the Adirondacks, I was asked to visit 
a gentleman at a hotel in the neighborhood who was said to be 
in an advanced stage of pulmonary phthisis. He was about 
forty years of age, and had been an invalid for three years. 
Upon examining him, I found, that in addition to his phthisis, 
he was suffering from a perineal abscess, and a congenital 
phimosis. The latter had caused a chronic balinitis by pre- 
venting the secretions from being removed, and the parts from 
being washed. The extremity of the organ was so painful that 
the slightest touch gave him great distress. I opened the 
abscess in the perineum and it soon healed. The pain from the 
accumulated secretions around the glans, continued with little 
amelioration, except when relieved by opiates, and I finally 
slit the prepuce and exposed the inflamed and ulcerated glans 
and thus relieved him of the greater part of his suffering. He 
afterwards said to me, *' Dr. I know now that if that operation 
had been performed when I was a boy, and I had been told 
anything about the normal condition of my genital organs, I 
would now be in good health, I would not now be dying from 
consumption. I blame it all on my parents. When I was a 
mere lad, I had every night a very painful erection which kept 
me awake the best part of the night. Again and again I went 
to my father and begged him to tell me where to go for relief, 
but he only laughed, and said it was all right. Like appeals to 
Others had a similar result. Finally the irritation became 



20 GENERAL CONSIDERATIONS. 

SO great that without any instruction I commenced to 
masturbate, and finally went frequently with loose women to 
such an extent that my health broke down, my lungs gave out, 
and now I am dying. I never knew until too late what was 
the cause of my frequent erections, and I was never told that 
any relief could be afforded by an operation." 

The most singular part of this matter is, that so much 
ignorance can exist where natural instincts alone might be 
expected to prompt man, as well as the lower animals. 

The education of the youthful mind in these matters need 
not be thoughtlessly commenced, or hastily terminated. A 
gradual and systematic formation of correct ideas and habits, 
should be fostered as the growth of the boy or girl progresses. 
And the various steps should be taken with due regard to the 
mental or physical developement of the child, and necessarily 
must be varied to suit this or that particular case. The educa- 
tion should neither be superficial, nor hurried. The teacher 
must feel the responsibility he is assuming, and have a thorough 
perception of his work on each point before he undertakes it. 
The perceptive faculties of children are often much keener 
than we generally give them credit for, and, like older 
folk, they have different mental and physical peculiarities, 
which must receive special study before the necessary knowl- 
edge is conveyed to them. If the pupil has exhibited signs of 
unusual sexual precocity, it would be well to point out the re- 
sults of all unhealthy familiarity with the genitals before dis- 
coursing upon their uses in the accomplishment of a most bene- 
ficent plan of nature, to imbue the mind with that laudable 
sense of fear which should invariably accompany any infringe- 
ment of the law. Fear is an essential element in controlling 
this class, which has many, very many members. So many in- 



GENERAL CONSIDERATIONS, • 21 

deed are in this class in all walks of life as positive indications 
that their parents though living in a civilized and christian 
community, have broken every law as thoroughly as if they had 
"lived and moved and had their being," where vice prevailed 
and moral laws were unknown. Such children are often nothing 
but insignias of disgrace to their ignorant, though, perhaps, well- 
meaning parents. 

With that other and much smaller class, who inherit healthy 
minds, as well as healthy bodies, with little or no disfigurement 
from exuberant natural passions, it is always safe to add to 
their general knowledge of anatomy and physiology some ad- 
ditional and special facts relating to the genito-urinary func- 
tions. The subject can be approached gradually, suiting the 
amount of information to the age of the child, and the general 
development of the perceptive faculties. The command to 
keep the hands away from the organs, if aided by the watch- 
fulness of a faithful nurse, or mother, will generally succeed in 
enforcing this sanitary edict. At the same time it is well to see 
that all sources of temptation to examine themselves should be 
removed. The tight clothing with which the limbs of most 
children are encumbered by night, as well as by day, should 
be removed. Nothing tight, or irritating, or exceedingly warm, 
should be allowed either in the day or in the night, but 
especially at night, because then there is the additional weight 
of the bed clothing to be borne. From the warmth and super- 
abundant moisture accumulating around the genitals irritation 
is engendered which naturally prompts the child to rub and 
finger its parts until the tendency to masturbation is fully 
formed, and the child is well on the road that leads to all sorts 
of excesses. Sometimes a warning voice reaches the innocent 
transgressor through the medium of a quack advertisement in a 



22 GENERAL CONSIDERATIONS. 

book or newspaper. Fortunately, these advertisements often 
send the patient to the family physician, instead of to the 
charlatan. Yet whatever evils may arise from such quacking, 
one good at least is often accomplished, namely, the immediate 
suspension of the pernicious habit, whatever may be its nature. 
I have had many cases where the patient's reformation and 
subsequent restoration to health originated from perusing quack 
advertisements.' I speak of this to show that the educated 
members of our profession are scarcely doing their duty to 
humanity by ignoring the importance, and by neglecting or 
making little of the subject. Fear of evil consequences is with- 
out doubt a great moral power in this world, and although it 
may not be the noblest propelling force, it cannot be dispensed 
with in the cases under consideration. We are all sadly 
human. Emerson, with a degree of truth, says that " there 
is a crack in everything that God has made," and this 
is undoubtedly true of poor human nature. We have 
not yet reached perfection and probably never will, and we 
must recognize the value of such a low moral force as fear in 
the enforcement of sanitary conditions in all matters relating to 
the sexual or genito-urinary organs. 

The usual and conventional objection to this variety of edu- 
cation is, that at such an early age the understanding is not 
ripe enough for such knowledge, and that it might lead to the 
very evil that it was designed to avoid. If it were not apparent 
to every one that the evils and the diseases under considera- 
tion were almost universal as a result of ignorance, then that 
idea might be entertained, but no one can possibly object 
under existing circumstances to giving the child legitimate 
knowledge on a subject of such vital importance, where 
ijisufHcient teaching has produced such unfortunate results. 



GENERAL CONSIDERATIONS. 2$ 

Acton publishes the remarks of a clergyman who seems to 
have been blessed with more than the ordinary amount of cler- 
ical common sense on this question. He says : "Advantage 
could and ought to be taken of the opportunity when a boy 
says his catechism to explain to him the meaning of some of 
the terms therein contained. When a child is taught to ' keep 
his body in temperance, soberness and chastity,' it would not 
be difficult to explain to him what chastity is, instead of leav- 
ing him to find it out as best he may. He might be given to 
understand that it does not merely mean that all indecency and 
foul language must be shunned. The child might be told that 
he must keep from meddling with his secret parts, except when 
the necessities of nature require it, and that any emotion he 
may experience in these members must not be encouraged, and 
all thoughts which originate in them must be avoided. And 
when he grows older every boy should be taught that chastity 
means continence ; that if he would be chaste he must not by 
any act of his own, or by the indulgence of lascivious imagina- 
tions, cause the fruit of his body to be expended. He should be 
taught that all such expenditure is a drain on his system, and 
weakens the powers which God has given him to be employed 
only in the married state. He may be sure that ' his sin will 
find him out,' and if he marries with his powers undermined by 
unlawful gratification it will be visited upon his children also. 
If he is old enough to understand the subject, the youth enter- 
ing upon puberty might have explained to him some of the mys- 
teries of life; probably it would not be incompatible with his age 
to explain to him that the life of the animal and vegetable king- 
doms is continued and increased through the power of repro- 
duction, with which the Creator endowed the whole produce of 
the earth, It is the nature of every herb that it * yieldeth seed,' 



24 GENERAL CONSIDERATIONS. 

and of the fruit tree yielding fruit that its ' seed is in itself ' (Gen. 
i, 12). It is the nature of every living creature *to be fruitful 
and multiply' (Gen. i, 28). This power of reproduction or of 
generation constitutes the very essence of life. To enable this 
vital function to be fulfilled, every plant and every animal is 
furnished with organs of reproduction. As it has organs of 
respiration for breathing the air, organs of motion, organs of 
digestion for assimilating its food, so it has organs of reproduc- 
tion for handing on the life it has received, and reproducing 
itself in its offspring. This is the most important function of 
the whole vital economy of every living form. We might 
further explain to him that our life is bound up with the repro- 
ductive organs of the body. Now what every young man, and 
boy also, ought to know about himself is this : The two appendages 
of the body, — of which we are too modest to speak, — but which 
the Holy Scriptures calls the stones, and medical men the testes 
or testicles, form the laboratory of the human body, where, by 
a process of which we are quite unconscious, the blessing given 
to man at the creation is being fulfilled, and out of the system 
a vital fluid which is the very 'essence of life,' the source of 
being, is being constantly produced from the time of puberty, 
to be employed, when he reaches maturity, not in the gratifica- 
tion of the lusts of the flesh but in the procreation of children. 
The boy might be taught the immense importance to the human 
constitution of this vital substance, the seed of the man which 
is elaborated by the organ of reproduction, and it should be 
made clear to him how terrible the consequences must be if the 
life be continually flowing away from the body. The oppor- 
tunity might be taken of informing the youth that many whose 
lives are outwardly pure have fallen into secret sins and wasted 
their substance in solitary indulgence. And the consequence 



GENERAL CONSIDERATIONS. 25 

of such indulgence is not limited to the act itself, but the vio- 
lated body becomes unable to contain its treasure, and as fast as 
it is elaborated the seed is poured away on the slightest provo- 
cation in sleep and in the performance of the acts of nature. 

" He might further be informed that many of the sicknesses 
to which we are subject may be traced to this cause, and that 
many of those complaints set down as nervous debility, much 
languor and loss of spirit, much feebleness of mind, much 
dimness of sight, much loss of manly bearing, — to which we 
must add many cases of the loss of reason and an imbecile and 
driveling old age, — are the inevitable result of the expendi- 
ture of the vital forces in sinful gratification. 

" I would further instruct a youth that this degrading prac- 
tice obtains such a hold upon any one indulging in it that he 
seems unable to free himself from its grasp. Again and again 
he yields to its importunity, and life ebbs away from him, — mind 
and body becoming undermined. It is a sad and melancholy 
truth that many whose childhood has been most pure and spot- 
less have fallen most deeply when their passions have been 
awakened through absence of all warning on the subject and in 
ignorance of the self-destruction they were committing." 

Besides this instruction given by the family physician, the 
tutor, or the schoolmaster under whose eye the ordinary school 
knowledge is inculcated, should maintain a degree of watchful- 
ness over the boy which would enable him to detect any private 
irregularities, and he should also add (with the advice of the 
physician) any further lessons as to the best methods of regu- 
lating generally the sanitary condition of the youthful pupil. 
Upon this point the same author says : " I maintain that a con- 
scientious schoolmaster's task does not end with providing for 
cleanliness, decency, and exercise among his boys. In spite of 



26 GENERAL CONSIDERATIONS. 

his assumed ignorance of the practice, masturbation and other 
vices may spread widely through the school unless careful 
supervision be employed. Against these secret evils there is 
no better safeguard within his reach than a steady endeavor to 
raise the moral tone of the whole school by means of the uppei 
forms, so that the older boys may of their own accord join in 
discountenancing any ungentlemanly or disgraceful conduct, 
Without some such auxiliary, the efforts of the best-intentioned 
master to prevent the practices, with their demoralizing accom- 
paniments and consequences, will be almost powerless. How 
diffused secret wickedness may become in schools appears 
every now and then in scandals so dreadful that the natural 
tendency of all concerned is to hush them up and forget them 
as soon as possible. Indeed, it is impossible not to sympathize 
with the feeling that to be obliged seriously to doubt as to the 
manliness and, in a rough way, of the purity of our large schools, 
would be a great calamity. And in the main, this confidence 
has been, no doubt, hitherto justified. Still there are points on 
which I think all concerned may be a little too confident, not 
to say remiss. One in particular I wish to mention. (I can hardly 
do more.) It seems to me clearly included within the scope of 
these remarks. I think a schoolmaster should be alive to the 
excessive danger of the platonic attachments that sometimes 
become fashionable in a school, especially between boys of very 
different ages. I am not speaking of ordinary boyish friend- 
ship, — than which there can hardly be a greater blessing, — either 
during boyhood or in after life. ^ ^ jj. I am speaking of 
what schoolmasters cannot be ignorant of, — the sentimental 
fancy taken by an elder boy to a younger, between whom there 
can be, in the regular course of the school, little natural com- 
panionship, and having about it a most unpleasant and danger- 



GENERAL CONSIDERATIONS. 2^ 

ous resemblance to abnormal passion. I know that such 
attachments have led to most melancholy results. I have been 
made aware that some public school men have declined master- 
ships in their own school because they knew the custom pre- 
vailed, — which they were alike unable to sanction and afraid to 
attack. I have been informed that it has been preached at, not 
obscurely, from school pulpits; and I could point to living men, 
with a wretched burden of recollection from it on their con- 
sciences, which they would give the world to erase." 

There is, no doubt, a vast deal of truth in what Mr. Acton 
says on the point of immorality in public and private schools, 
and that the pupils, — good, bad, and indifferent, — need watch- 
ing ; but I would hardly agree with him in looking with a sus- 
picious glance on all the friendships of boys differing in age 
with each other. I would see that the precepts inculcated in 
the previous pages were frequently dwelt upon, exercise a due 
amount of care in rooming, and observation of their habits, and 
leave the rest to the innate manliness of the boy himself. 



CHAPTER II. 

THE GENITAL APPARATUS. 

Anatomy and Functions of certain portions of the Male and Female Genital 
Organs — Erectile Tissue — Peculiarities of Erectile Tissue — Unstriped 
Muscular Fibres in the walls of the Trabeculse — Blood Supply of the 
Erectile Tissue of the Penis — Buck's fascia — Structure of the Corpora 
Cavernosa and Corpus Spongiosum — Action of Muscles on those Organs 
— The Glans Penis — Changes in the glans from Masturbation and Sexual 
Excess — Dorsal Artery of the Penis — Membranous Urethra — Cowper's 
Glands — Character of the Secretion — Prostatic Urethra— Veru Montanum 
— Caput Gallinagmous — Prostatic Ducts — Ejaculatory Ducts — Morbid 
changes from Masturbation — Prostate Gland — Internal Structure — Vascu- 
lar Supply — Communication of Prostatic Plexus with Hemorrhoidal veins 
— Influence of Constipation on the Prostate and adjacent Parts — Testicles 
— Tubuli Semeniferi — Cells in which Spermatozoa are manufactured — Vas 
Deferens — Vesicul8e Seminales^ — Parts of Female Genitals concerned in 
Masturbation — Clitoris — Labia Minora, etc. 

In order to gain a clear conception of the diseases we are 
about to study, it will be advisable to briefly examine the 
various tissues which enter into the formation of the genital 
organs as they exist in health, and also to study the functions 
of the organs in their healthy state, before we proceed to the 
consideration of those morbid changes which take place in the 
tissues as the result of excesses, or of unnatural habits. 

In the space known as the perineum are the organs to be 
studied. Here we find located the neck of the bladder, the 
prostate gland, urethra, penis, scrotum, testicles, anus, and 
lower part of the rectum. In the female, the same region con- 
tains the labia, clitoris, urethra, mons veneris, glands of Bartho- 
line and their ducts, and the entrance to the vagina. 



THE GENITAL APPARATUS. 29 

ERECTILE TISSUES — PENIS. 

Erectile tissue invariably consists of interlacing bands of 
yellow elastic, and white fibrous tissue, and unstriped muscular 
fibres, which form irregular spaces, enclosing rich plexuses of 
bloodvessels. It forms the principal part of the penis, being 
found there in the form of three cylindrical masses, viz : the 
corpora cavernosa, and the corpus spongiosum. Erectile tissue 
is also found in the labia minora, clitoris, vaginal walls and 
ovaries, the nipple of the mammary gland, and the schneiderian 
membrane. The principal characteristic of this tissue is its 
great capacity for distension. 

The corpora cavernosa, the two upper cylinders of erectile 
tissue which form the penis, arise from tue tuberosity of the 
ischium, by two crura, which unite under the pubes and con- 
tinue on until they terminate in two rounded extremities in the 
expanded end of the corpus spongiosum, known as the glans 
penis. Each cylinder is surrounded by a dense fibrous cover- 
ing in which elastic fibres predominate, and in which also are 
situated muscular fibres of the unstriped variety. This incloses 
the erectile tissue proper. The erector penis, a muscle which 
is intimately connect!ed with the crura, arises from the inner 
side of the tuberosity of the ischium (Gray) from the crus, and 
from the ramus of the pubes, and passing upwards and inwards 
terminates in an aponeurosis that is attached to the side and 
under surface of the crus. This muscle compressing the crura 
prevents the return of the venous blood, and thus assists in 
keeping up an erection of the organ. 

The corpus spongiosum, the remaining cylinder of erectile 
tissue, is situated immediately beneath the junction of the 
corpora cavernosa. It commences in front of the triangular 



30 THE GENITAL APPARATUS. 

ligament by a slight enlargement, called the bulb, passes forward 
and ends in another expansion, the glans penis, which, as before 
stated, receives the rounded end of the corpora cavernosa. The 
glans penis is covered by a mucous membrane, the continuation of 
the mucous membrane of the urethra. In a normal condition 
the glans has a pinkish color and is highly sensitive ; and it is 
protected by a fold of the integument covering the penis called 
the prepuce. Where masturbation has been indulged in or the 
party has been guilty of excesses for any great length of time, 
the mucous covering of the gland assumes more of the charac- 
ter of ordinary integument and loses its sensitiveness, while the 
prepuce, instead of covering it, is wrinkled back to the base of 
the corona glandis. The spongy portion of the urethra is 
contained in the corpus spongiosum, extending from the 
membranous portion to its termination in the meatus urinarius. 
There is nothing special to be noted in this portion of the 
canal, except that the ducts of Cowper's glands open on its 
floor about half an inch from its commencement. The corpus 
spongiosum is intimately connected with the accelerator 
urinse, a m'kss of muscular fibres which are arranged in 
three layers in the median line of the perineum. The layers 
arise from the tendinous center of the perineum. The ante- 
rior layfjr of fibres is inserted into the side of the corpus cavern- 
osum, but the principal portion of them pass up to the dorsum of 
the penis, terminating, in a fibrous expansion which, when the 
muscles contract, compresses the dorsal vein. The middle fibres 
surround the bulb and the adjacent portion of the corpus spongi- 
osum and join with the fibres of the opposite side on the superior 
portion of the same body. The posterior portion or layer is 
spread out on the anterior ligament. This muscle assists in 
erection by compressing the bulb and a portion of the corpora 



THE GENITAL APPARATUS. 3I 

cavernosa. It also assists in expediting the flow of urine, and 
in the expulsion of the last few drops of urine which remain in 
the lower part of the urethra. The other muscles of the peri- 
neum have no special relation to the points under consideration, 
and need not therefore be studied here. 

The bulb of the corpus spongiosum can be felt through the 
ridge in the median line of the perineum. The membranous 
portion of the urethra extends from the apex of the prostate to 
the triangular ligament in front. Around this portion of the 
urethra is attached the compressor urethrse, or *' cut-off " muscle. 
(It is important to remember the attachments and action of 
this muscle, as we shall see further on.) It arises from the 
ramus of the pubes on each side, passes inward and divides 
into two parts, one going above the urethra and the other going 
below it, the two parts ultimately uniting in the median line. 
Immediately underneath this muscular layer there is a circular 
layer of unstriped muscular fibres, which is continuous with 
the circular fibres of the prostate and bladder behind, and with 
the circular layer of fibres in the spongy urethra in front. The 
muscle is supplied by muscular branches of the pudic nerve. 
Irregular or spasmodic action of this muscle may interfere both 
with the expulsion of the urine and the emission of semen. 

The membranous portion of the urethra measures three- 
quarters of an inch in length. Underneath its anterior part the 
glands of Cowper are situated. They are surrounded by the 
transverse fibres of the compressor, and their ducts, an inch in 
length, pass forwards and open on the floor of the bulbous por- 
tion of the canal. They secrete a viscid, glutinous fluid which 
appears in small quantities when there is much sexual excite- 
ment. It is exceedingly profuse when there is much relaxation 
of the genitals from masturbation or excessive sexual inter- 



32 THE GENITAL APPARATUS. 

course. It resembles the white of an uncooked egg more than 
anything else. It is said to perform the same function in the 
male that the secretion of Bartholin's gland does in the female, 
viz : the lubrication of the organ during sexual intercourse. 

The prostatic portion of the urethra is situated in the sub- 
stance of the prostate gland, and extends from the neck of the 
bladder to the apex of the prostate, or commencement of the 
membranous portion of the urethra. It measures one inch 
and a quarter in length. On the floor of the prostatic urethra, 
the body known as the veru montanum or caput gallinaginous 
is situated. It is raised one or two lines above the level of the 
mucous membrane. The supply of nervous elements, and fine 
capillary bloodvessels to this organ is much greater than it is 
to any other portion of the urethra, hence it is supposed to be, 
and undoubtedly is, the principal seat of the peculiar sensations 
which terminate the action of coitus. In front of the veru 
montanum is a pouch called the sinus pocularis. At the orifice 
of this pouch are found the orifices of the ejaculatory ducts 
through which the seminal fluid is poured into the canal of 
the urethra. The ducts are formed by the union of the duct 
of the vas deferens with the ducts of the vesiculae seminales. 
On each side of the veru montanum the ducts from the pros- 
tate glands open. In cases of confirmed masturbators, all 
these ducts are immensely increased in size and the veru mon- 
tanum is elongated and hypertrophied to such an extent as to 
occasionally afford an obstacle to the passage of the sound or 
bougie, catching on the point of the instrument, and very 
liable to be torn. The sound in passing over this portion of 
the canal also causes intense pain, a point which I regard as 
diagnostic of onanism, or excessive sexual indulgence, except 
where inflammation of the prostate exists of an acute char- 



THE GENITAL APPARATUS. $^ 

acter. The penis, which is made up of all the tissues just 
described, has an exceedingly loose integumentary covering, 
which contains little or no subcutaneous fat. The integu- 
ment is prolonged over the glans to form the prepuce. In 
a healthy condition, the prepuce should cover the glans and 
protect it. When masturbation has been persisted in for any 
length of time, the veins of the integumentary covering of the 
penis become very much enlarged and tortuous, and the skin 
itself becomes of a dull yellow color, with a tendency to wrinkle. 
The dorsal artery of the penis may be felt pulsating between, 
in the furrow made by the union of the corpora cavernosa. 
The penis is held in position by a dense layer of fibrous tissue, 
which forms the suspensory ligament. It is attached to the sym- 
physis pubis, and thence spreads out over the penis, envel- 
oping the corpora cavernosa and then splitting to form a sheath 
for the corpus spongiosum. This tissue is known as Buck's 
fascia, and is continuous below with the superficial layer of 
the triangular ligament. 

The vascular plexuses in the erectile tissue of the penis 
secure their principal supply of blood from the dorsal artery 
of the penis (a branch of the internal pudic) though the artery 
of the bulb, and the arteries of the corpora cavernosa, also fur- 
nish some. From eight to twelve branches arise from the main 
trunk, and surround the penis, anastomosing with those below, 
and finally piercing the corpora cavernosa. Langer says that 
some of the arteries terminate in capillaries, as other arterial 
capillary arteries do, while the others terminate directly 
in the venous spaces of the erectile tissues by funnel-shaped 
orifices. The arteries of the corpus spongiosum terminate in 
ordinary capillaries. Rouget says, " the arterial trunks in the 
bulb and at the roots of the corpora cavernosa do not divide 



34 THE GENITAL APPARATUS. 

in the usual way into dichotomic branches, but are surrounded 
on all sides by branches of vessels, which arise from three to 
ten in number, from short common trunks. These vessels are 
not merely short diverticula, but traverse for some distance the 
large sinuses of the corpora cavernosa and of the bulb, and 
penetrate, after numerous anastomoses and subdivisions, especi- 
ally about the periphery, the muscular trabeculae. After travers- 
ing these fibres, the arteries pass through the surface, through 
slit-like openings ; but from their origin to their termination 
in the muscular fibres, the vessels from the arterial branches 
are twisted on themselves in abrupt and closely compressed 
spiral folds, interlacing, entwining, and anastomosing, so as to 
form a sort of vascular tangle, and this, unlike any simple flex- 
ions which a slight distension suffices to obliterate, persists 
during even complete erection, and closely resembles a beauti- 
ful network." 

The penis receives its nervous supply from branches of the 
pudic, and the cavernous plexus of the sympathetic. The 
latter is distributed mainly to the erectile tissue of the corpora 
cavernosa, while the former is distributed to the integument 
and to the urethra (KoUiker). 

PROSTATE GLAND. 

The gland which surrounds the prostatic urethra also plays 
an important part in the diseases under consideration. It 
extends from the bladder to the membranous urethra, the 
muscular fibres being continuous behind with the circular 
fibres at the neck of the bladder, and in front with the circular 
fibres of the membranous part of the urethra. The principal 
part of the muscular tissue of the gland is found at the cir- 
cumference, while the follicles which form the glandular portion 



THE GENITAL APPARATUS. 35 

of the organ are located in the interior. From the cortical 
muscular layer, bands of muscular fibres pass to the interior 
or center of the gland, and between these cords or bands all 
the glandular tissue of the prostate is situated (Strieker). 
There are also bands of striped muscular fibres, blending or 
passing between the layers of smooth muscular fibres. Some 
few of these bands pass also into the interior of the gland, or 
glandular substance. 

The nervous supply to the gland is very considerable. Large 
nerve trunks containing a great number of ganglion cells pass 
upwards to the superficial muscular layer. Medullated nerve 
trunks are also found in the cortex, connected with large gan- 
glion cells. 

A plexus of veins, closely packed, also surrounds the 
gland. The veins are of greater size than usually obtains in 
ordinary venous plexuses. The dorsal vein of the penis ter- 
minates in this plexus, returning the blood to this point from 
the principal portion of the penis. This plexus of veins also 
communicates with the hemorrhoidal and inferior mesenteric 
plexuses. It can thus be seen what an important factor con- 
stipation would be in promoting congestion of the prostate 
and its connections. Any obstruction at this point, no matter 
what its nature, must necessarily conduce to a continuance of 
nocturnal pollutions and other allied affections. Indeed, in- 
direct obstruction to the return circulation does more harm 
than is generally supposed. With regard to the function of the 
prostate, there is some difference of opinion. It undoubtedly 
performs several offices. In the first place, it furnishes some 
of the liquid which is required to dilute the seminal fluid. The 
intermixture occurs at the time of the orgasm. Then the 
muscular fibres, are so arranged that during contraction 



$6 THE GENITAL APPARATUS. 

they press on the follicles and empty them at the time of 
ejaculation. In this way only could a sufficient quantity of 
prostatic fluid be obtained. Besides this function, the gland 
undoubtedly acts as a sphincter muscle to the neck of the 
bladder. 

Every patient with functional or organic disease of the geni- 
tals or any suspected constitutional disorder arising therefrom 
should have a careful and thorough examination of the peri- 
neum and a rectal exploration of the prostate gland. When 
it is enlarged and highly sensitive, the soreness and enlarge- 
ment may be felt outside by pressing firmly with the finger in 
the median line an inch above the verge of the anus. Before 
examining per rectum the patient should be placed in a 
lithotomy position and a sound carefully introduced into the 
neck of the bladder ; the left index finger is then to be 
slowly inserted through the anus. In doing this special atten- 
tion should be paid to the fact that if undue force is used there 
will be a spasmodic contraction of the sphincter ani which will 
thus oppose the introduction of the finger and cause intense 
pain. A useful means of preventing this is to press firmly on 
the sphincter before the attempted introduction, and finally to 
rotate the finger as it enters. Just inside the sphincter, the 
finger, pressed upward, v/ill come in contact with the sound 
separated only from it by a thin layer of mucous membrane. 
This is the membranous portion of the urethra. As the fin- 
ger is carried on it is gradually separated from the sound, that 
is, the thicker tissue of the prostate intervenes so that it takes 
some degree of pressure to ascertain the exact position of the 
sound. The gland can easily be distinguished and the exam- 
ination wall or should furnish evidence of the amount of con- 
gestion or inflammation existing, if any, as well as the degree 



THE GENITAL APPARATUS. 37 

of enlargement. In cases where excessive masturbation is 
suspected firm pressure over the whole rectal portion of the 
gland, on the removal of the sound, will be followed by a 
considerable discharge of prostatic fluid. In healthy states 
this will not occur. The question is sometimes asked, what 
does the normal gland feel like through the rectum of the 
adult ? As a student the question often puzzled me quite as 
much as it did my interlocutor. Without taking into consider- 
ation the measurements of the gland which can be approxi- 
matively made out, the question can be indirectly answered 
thus : if there is no feeling of tension in the rectum when the 
finger is resting on the gland, or of soreness or of special 
discomfort at that point, the exact dimension of the gland is of 
little importance. The probabilities are that the gland is 
normal in size and condition. A feeling of tension over the 
gland, as if the membrane were tight and distended, and a 
feeling as if the gland were protruding into the gut shows 
abnormality in size even when there is no special tenderness. 
Besides this, pressure on the gland in the sensitive condition 
mentioned, produces a tendency to evacuate the contents of 
the bladder. 

The passage of hardened fecal matter over a diseased gland, 
that is a gland diseased from excess or from pollutions, will 
squeeze out the prostatic fluid and make the unfortunate 
patient believe that it is a discharge of semen. 

THE TESTICLES. 

The testicles in health are firm to the touch and not sensi- 
tive unless the pressure made is excessive. The left one hangs 
a little lower than the right. In persons who are the victims 
of evil habits, the organs are generally soft and flabby to the 



38 THE GENITAL APPARATUS. 

touch and do not give that sense of firmness so characteristic 
of the healthy testicle. The testicle, like the brain, has three 
coverings, a serous, fibrous, and vascular coat. The vascular 
covering closely invests the lobules of the testicle. The tunica 
albuginea covers the tunica vasculosa, and sends fibrous diver- 
ticula into the interior of the testicle, between which are 
arranged the lobules of the testicle. The serous covering, or 
tunica vaginalis, is derived from the peritoneum and forms the 
most external covering. Beeres gives the number of lobules 
as 250, but there are probably more. Each lobule is composed 
of tubes, the tubu'l seminiferi about sixteen feet in length. 
Each testicle has about 500 tubes. The epithelial lining 
of these tubes consists of large corpuscles having many nuclei, 
and it is in these corpuscles that the spermatozoa are formed. 
These tuber unite to form larger tubes, which pass out at the 
back part of the testicles, and passing upward form the globus 
major of the epididymus, the body of the epididymus and the 
globus minor. From the extremity of the globus minor the 
excretory duct of the testicle, the vas deferens, is given off. 
This duct passes upward to the inguinal canal through which 
it passes, and then dipping into the pehds by the side of the 
bladder to its base where it joins with the duct of the 
vesiculce seminales to form the ejaculatory ducts which (as 
before stated) pass through the prostate, and open on the floor 
of the prostatic urethra, at the upper edge of the sinus pocu- 
laris. The vas deferens is two feet in length, forming the prin- 
cipal part of the spermatic cord, and can easily be recognized 
by the touch because it feels under the finger like a hard cord. 
It conducts the spermatozoa from the testicles to the vesiculae 
seminales — receptacles or reservoirs for the seminal fluid. 
These reservoirs are two irregularly shaped sacs, about two 



THE GENITAL APPARATUS. 39 

inches in length, situated at the base of the bladder and resting 
on the rectum. They form the lateral boundaries of the space 
at the base of the bladder which is uncovered by peritoneum 
and which can be touched by the finger as it passes over the 
posterior edge of the prostate in the rectum. The vesiculae 
seminales manufacture a secretion of their own which mixes 
with the spermatic fluid brought there by the vas deferens. 
The surplus semen remains in these receptacles or storehouses 
until it is thrown off in sexual intercourse, in masturbation, or 
in nocturnal emissions. Because these vesicles after death 
often contain no spermatozoa, some writers think that the 
unused semen is absorbed, and that there is no accumulation 
of it in the vesicles. There is no proof of this absorption. In 
man the manufacture of seminal fluid is going on constantly. 
If the patient is in a normal condition, and his genital organs 
are fulfilling their legitimate functions in a proper way the 
surplus stock is disposed of naturally. If the patient is sick 
and the vital forces below par, the secretion must be 
impaired. When the disease lasts long enough to threaten 
life, it is reasonable to suppose that the secretion must be 
very much less, if not altogether lost, so that after death no 
seminal fluid exists in these storehouses. This I think prop- 
erly explains the absence of liquid on post mortem examina- 
tions. 

FEMALE ORGANS CONCERNED IN MASTURBATION, ETC. 

The mons veneris covers the pubes, and acts as a protector 
during intercourse, preventing injury from pressure on the 
sharp edges of the bones. It consists of a thick layer of integu- 
ment covered with hairs, and supported by a, considerable 
quantity of subcutaneous fat. 



40 THE GENITAL APPARATUS. 

The labia majora extend from the mons veneris on either side 
down to the anterior part of the perineum. They consist of in- 
tegument, mucous membrane, dense cellular tissue, muscular 
fibres and large sebaceous glands, and the terminations of the 
round ligament of the uterus. The labia minora are made up 
principally of erectile tissue similar in structure to the erectile 
tissue of the penis, and mucous membrane; they are from an inch 
and a half to two inches in length. They commence above the 
clitoris and run down internal to the labia majora and become 
lost on the sides of the entrance to the vagina; at their com- 
mencement above, each labium splits in two layers which sur- 
round the clitoris, forming the preputium clitorides, and the 
frenum of the clitoris (Gray.) 

The clitoris consists of two crura of erectile tissue like the 
corpora cavernosa of the penis, attached behind to the rami of 
the pubis and ischium, and they terminate in front in a sensi- 
tive point analogous to the glans penis. It has also, like the 
penis, a suspensory ligament, and two small muscles correspon- 
ding to the erector penis. 

The female urethra extends from the neck of the bladder to 
the lower portion of the vestibule. The vestibule is a triangular 
space, bounded on each side by the labia minora, also by the 
clitoris, and below by the entrance of the vagina. The urethra 
is an inch and a half in length, and is made up of muscular 
tissue and mucous membrane and a layer of erectile tissue. It is 
about an inch below the clitoris. It is more sensitive than the 
male urethra, and is often employed by masturbators as well as 
the clitoris for purposes of excitation. Hair pins, lead and 
slate pencils, leather thongs, sealing wax, and other like sub- 
stances are passed in and out of the canal, until the necessary 
degree of excitement is produced. They often slip from the 



THE GENITAL APPARATUS. 4I 

fingers of the operator into the bladder, where they remain to 
form nuclei for cystic calculi. 

The vagina also contains together with its muscular and 
mucous layers a layer of erectile tissue rich in nerves. It is 
highly sensitive and is often employed by masturbators, who in- 
troduce foreign bodies, such as candles, stiff rubber tubes, etc., to 
produce an artificial excitement. It has been stated to me by 
good authority, that a large income is derived from the sale of 
a rubber machine, made for the purpose mentioned. They are 
said to be manufactured in some of the prominent factories in 
the country, and sold by means of unscrupulous female agents 
to school girls and others who will not take the risks incurred 
in ordinary sexual intercourse. 

The glands of Bartholin are two in number, and are situated 
on each side at the entrance to the vagina. The glands open by 
ducts in front of the hymen ; they secrete a liquid which is 
analogous to that manufactured by the glands of Cowper. This 
secretion is poured out in large quantities when there is much 
sexual excitement, and it serves to lubricate the parts during 
coitus. During the orgasm there is a discharge from the ducts 
of these glands analogous to the ejaculation of semen in the 
male. 

The clitoris and the labia minora are supposed to be the seat 
of the sensation in coitus. When masturbation has been in- 
dulged in to any great extent the clitoris generally loses its 
sensitiveness, though at times it is hypersensitive, and it is elon- 
gated and hangs down, often as far as the meatus urinarius. 
The labia majora and the whole entrance to the vagina is 
intensely red and congested, and the parts are often bathed in 
a profuse secretion of mucus. The labia minora are elongated 
and pulled out beyond the edge of the labia majora. I have 



42 THE GENITAL APPARATUS. 

seen cases in the hospital where they resembled the ear of a 
small spaniel; when the hymen exists, it will be found relaxed, 
and it does not close as much of the aperture of the vagina as it 
does in a healthy condition. 



CHAPTER IIL 

The Seminal Fluid and the Mechanism of Erection. 

Physiological Properties, and composition of Seminal Fluid — Gross Ap« 
pearances — Spermatozoa — Peculiar movements under the Microscope — • 
— Chemical Composition of Semen — Various Quantities formed and Ejac- 
ulated — Secretion of Prostate and Cowper's Glands as part of Seminal Fluid 
— Natural and Morbid Secretions that may be mistaken for Semen — Mu- 
co-purulent Secretion in Prostatitis, Urethritis and Cystitis — Mixture of 
Mucus with Epithelial Cells, Chylous Urine, etc. — Distinguishing Char- 
acteristics of each — Mechanism of Erection — Nerve Centers Governing 
Erection — Function of the Cerebellum — Effects of removal of the Organ 
— Clots and Tumors on the Cerebellum — Emissions produced by Sliam- 
pooing the occiput — Genito-spinal Center — Sympathetic Nerve Influence 
— Analogy between the act of Blushing and Erection — Influence of the 
Mind — Cases of Partial Erection. 

The seminal fluid, as stated before, is a product of several 
distinct glands, differing in chemical composition and physical 
properties. A large constituent of the fluid is furnished by the 
prostate and Cowper's glands, the remainder by the testicle and 
the vesiculse seminales. The prostatic secretion is opaque, the 
secretion from Cowper's glands is transparent and viscid. The 
fluid in the epididymis is slightly opaque. The secretion of the 
vesiculse seminales which I have only had an opportunity to 
examine after death, is sometimes opaque and other times 
transparent. In two cases where death resulted from Bright's 
disease of the kidneys, it was transparent and of a jelly-like 
consistency. In a patient who died of phthisis in Charity 
Hospital, it resembled seminal fluid, being both viscid and 
opaque, and containing a few spermatozoa. 

Seminal fluid is of a dull white color, alkaline in reaction, 



44 THE SEMINAL FLUID, ETC. 

having a strong odor of lime. It is viscid, and rapidly gelatin- 
izes on exposure to air. It contains salts of soda, lime, potas- 
sium, and a peculiar protein compound, called by Frerichs 
birioxide of protein. There is also a phosphorized fat in the 
body of the spermatozoa. 

The procreative factors of the seminal fluid are known as 
spermatozoa, and they are its principal constituents. They 
were first discovered by John Ham, who by a variety of experi- 
ments proved that they were the fertilizing element in the male. 
For instance, he found that if the spermatozoa were removed 
carefully from the seminal fluid by filtration, it lost all power of 
impregnating the female ovum. It has also been ascertained 
that they are entirely absent in some animals, except at the 
time of heat. The spermatozoon resembles a tadpole in ap- 
pearance, having a large head and a prolongation which re- 
sembles the tail. Under the microscope they appear to be pos- 
sessed of rapid propulsive power, moving rapidly in every di- 
rection with an undulatory motion very much like the swim- 
ming movements of the tadpole. This power of movement or 
motion may, under proper conditions, continue for forty-eight 
hours without being outside of the genital organs. They lose 
that power when thrown into water. KoUiker states that strong 
solutions of salt, sugar or albumen, " will restore the motion 
which has been lost by the action of water." The active move- 
ments of the spermatozoa will continue in the vagina for a 
period of eight days (Strieker.) In connection with the 
spermatozoa, there are also found seminal granules, measuring 
^oQ-th of an inch in diameter. Nothing is known concerning 
them, but it is probable that they are undeveloped spermatozoa. 

Spermatozoa may be considered as embryonic cells, from 
which all cells or all tissues are derived. The conditions necessary 



tHE SEMINAL FLUID, ETC. 



45 



for their development are that the spermatozoa should become 
located in the ovule of the female, and receive there the sus- 
tenance necessary for the developmental changes. 

In this connection the following table from Acton will be of 
interest as showing the result of various examinations of the 
vesicul^ : 









Examined 


Age. 
20 


Condition of Vesiculae Seminales. 


Condition of Vasa Deferentia. 


hours after 
death. 


Slightly viscid ; brown tint 


Starchy 


II 


20 


Starchy, and gelatinous 


Few animalcules; not brown 


4 


27 


Partly thick and partly thin 
secretion 




10 


27 


Few spermatozoa, but glo- 


Healthy, with few spermatic 


32 




bules 


animalcules 




27 


Gelatinous; well-formed ani- 


No distinct animalcules, glo- 


12 




malcules 


bules 




29 


Gelatinous, thick, globules 


No fluid in 


3 


30 


Similar to that in vasa def. 


Numerous animalcules in 
active motion 


6 and 48 


31 


Fluid thick at fundus, in the 
interior, fluid 


Globules and fragments 


27 


32 


Fluid opaque, purulent 


Cream or purulent appear- 


16 


30 


Mucilaginous ; animalcules 
numerous 


ance 
Cream-like globules 


22 


32 


Purulent ; animalcules abun- 
dant 


Few animalcules 


32 


33 


Small in quantity, brown, 


Dilute, purulent — animal- 


15 




opaque 


cules few 




33 


Small in quantity ; no ani 


Small particles ; large glo- 


26 




malcules 


bules 




33 


Globules ; no animalcules 


Minute globules ; no ani- 
malcules 


6 and 36 


39 


Showed no animalcules ; no 


Purely purulent, with glo- 


2 




globules 


bules ; no animalcules 




39 


Gelatinous ; no animalcules 


Of a cream or purulent co- 


6 




or globules 


lor ; no animalcules 




41 


Mucilaginous ; many ani- 
malcules 


Particles, but no animalcules 


58 and 68 


42 


Slightly opaque ; abundant 
animalcules 


A few animalcules 


37 


49 


Animalcules abundant, dead 


Abundant animalcules, lively 


10 and 17 




in seventeen hours 


ten hours 




57 


Abundant vestiges of ani 


Purulent ; animalcules abun- 


5 




malcules ; few distinct 


(i.mr dead 





4^ THE SEMINAL FLUID, ETC. 

" From the above table it appears that the spermatozoa, or 
spermatic animalcules were found equally in the vesiculas semi- 
nales and in the vasa. It is curious to remark that, in all the 
cases in which spermatozoa were found in the vasa deferentia, 
similar animalcules were noticed in the vesiculse seminales. In 
cases in which the body was examined a few hours after death 
the spermatozoa were found alive, and moving actively, while in 
a few hours later they were motionless and dead, and warmth 
had no effect in re-animating them. In some cases the animal- 
cules were not perfect, portions only of imperfect spermatozoa 
being found. In other cases no animalcules could be discov- 
ered either in the vasa deferentia or vesiculae ; they were re- 
placed by large or minute globules, small particles, or fragments. 
The age of the individual appeared to have little to do with this 
condition of the spermatozoa, or, indeed, with their presence, 
numbers, or total absence. It is curious further to remark that, 
although spermatozoa were found frequently in the vesiculae 
and vasa deferentia, they were only found twice in the testes. 
The fluid expressed from the testes was transparent, generally 
contained globules nearly equal in diameter to the blood cor- 
puscles, and invariably contained dense particles, apparently 
spherical, from ten to fifteen times smaller. Dr. Davy thinks, 
first, that chronic wasting diseases terminating in death arrest 
the secretion of the testes, or the production of those animal- 
cules on which there is much reason to believe the active powers 
of the semen depend. Secondly, that the contents of the vesi- 
culae and vasa deferentia, under the influence of disease, retain 
their characteristic qualities longer than the contents of the 
tubuli ; and, thirdly, that there is least fluid in the vesiculae and 
in the vasa deferentia, and that it is most altered in instances of 
chronic diseases of the abdominal viscera, and especially 



tHE SEMINAL FLUID, ETC. 4^ 

of the intestines." — Edinburgh Med. and Surg. Jour., vol. 
I. p. 14. 

The seminal fluid when not removed by intercourse, accumu- 
lates in the vesiculae seminales, and is thrown off at night 
under the influence of lascivious dreams. Every man in a 
healthy condition is subject to these emissions at periodic in- 
tervals. The length of time between these emissions depends 
on peculiarities of temperament, habits and conditions of life. 
As a general rule it may be stated that seminal ejaculations 
occur once at least in two or three weeks. Still it is not indi- 
cative of an unhealthy condition when emissions occur once a 
week. Oftener than this, however, is generally a sign of undue 
irritability and relaxation of the genital organs, the result of 
sexual excess or masturbation. 

Emissions are not peculiar to men. Women also have them 
at night, and accompanied by the same sensations and lasci- 
vious dreams which characterize their occurrence in the oppo- 
site sex. The secretion poured out is formed in the glands of 
Bartholin, and is used for lubricating purposes, but under the 
influence of unsatisfied desires and morbid mental excitement, 
it is manufactured in excessive quantities, and ejected, distend- 
ing the duct as it passes out, thus probably assisting in the pro- 
duction of the orgasm. Except in coition, healthy women 
are never subject to these discharges. They do not, however, 
occur invariably from venereal excesses ; for any chronic con- 
gestion of the uterus, ovaries, or vagina, or of the glands of Bar- 
tholin, may produce frequent nocturnal emissions in the female. 

The quantity of seminal fluid thrown off depends on the 
previous habits of the individual. If he is plethoric, and at 
the same time continent, the quantity is large. If intercourse 
is freely indulged in the amount is comparatively small. The 



4^ fHE SEMINAL FLUID, ETC. 

quantity in each emission varies from a drachm to half an ounce. 
When there is congestion of the prostate, or inflammation of 
the prostate, chronic in character, or much irritability of the 
genital organs the amount of seminal fluid ejected is increased, 
its viscidity lessens and it often assumes a slightly yellowish 
tinge. The secretions which may be mistaken for spermatic 
fluid are in order of frequency : 

Secretion of Cowper's glands. 

Prostatic secretion. 

Muco-purulent secretion of Prostatitis. 

Muco-purulent exudation of Urethritis. 

Muco-purulent exudation of Cystitis. 

Mucus mixed with epithelial cells. 

Chylous urine. 
All of these discharges are sources of anxiety to timid and 
nervous patients. A person who has at any period of his past 
life misused his genital organs, is exceedingly apt to regard 
every unusual secretion as unmistakable evidence of seminal 
losses, and weakness of the genital organs. If the patient is 
unfortunately led to consult an advertising practitioner, he will 
probably have his fears confirmed. He is told that the dis- 
charge is seminal fluid, and that the involuntary loss is a posi- 
tive sign of approaching impotence. Indeed it is not an un- 
usual thing for these imposters to exhibit under the microscope 
specimens of seminal fluid, and claim that it is a portion of the 
fluid left by the patient for examination. In this way they 
work on the morbid sensibilities of their patients, and reap 
rich harvests as the result of their detestable deceit. 

The history of each case is generally sufficient for a diagnosis, 
but if the history is not clear, a microscopical examination of the 
suspected secretion will determine its character by the presence 



THE SEMINAL FLUID, ETC. 49 

or absence of spermatozoa. Spermatozoa are rarely seen in 
any fluid but the seminal fluid. Occasionally, a few spermatozoa 
may be seen in the urine after an emission, but they are rarely 
if ever found in the secretions previously mentioned. 

The secretion of Cowper's glands is transparent and viscid, 
like the white of an uncooked egg. It resembles pure mucus. 
Where intense sexual excitement exists or where there is much 
relaxation of the genital organs, the secretion is poured out in 
large quantities. In a healthy state of the organs, a small 
quantity only is used for purposes of lubrication. The glands 
probably serve the same purpose in the male that the glands of 
Bartholin do in the female. The absence of opacity, and of 
spermatozoa, renders the secretion easy of recognition. 

The opaque, muco-purulent secretion which characterizes 
gleet is often confounded with seminal fluid. Persons who have 
masturbated are apt to attribute the discharge to their early in- 
discretion. In the majority of such cases there is a history of 
preceding gonorrhoea. The exudation usually occurs in the 
morning, filling up the meatus urinarius. It is yellower than 
semen, and not so viscid. The peculiar odor of semen is also 
absent. Under the microscope, it will be seen to consist of 
pus and epithelial cells. No spermatozoa will be found unless 
the patient has had an emission the night previous to the ex- 
amination. 

The mucous secretion of the urethral canal sometimes be- 
comes temporarily opaque, from the admixture of epithelial cells. 
The opacity usually lasts a day or two and then disappears. I 
have known it to occur during a paroxysm of intermittent fever. 
The use of sounds for the relief of irritation in various parts of 
the urethral canal will often occasion it. So also will prolonged 
coitus under the influence of alcohol. The probabilities are 
4 



$0 THE SEMINAL FLUID, ETC. 

that it never occurs when the mucous membrane throughout 
the canal is in a healthy state. 

In prostatitis and cystitis, the urine may contain large quan- 
tities of mucus and pus. The mixture of these in ammoniacal 
urine, forms a gelatinous stringy mass which sinks to the bottom 
of the liquid and adheres to the side of the vessel. In 
prostatitis and cystitis there is pain on micturition, and a fre- 
quent desire to micturate. The opaque exudation of muco- 
pus appears with the last parts of the urine. In prostatitis, 
acute or chronic, the passage of fecal matter from the rectum 
may force out the secretion into the urethral canal. Patients 
invariably regard this as semen and are much alarmed. An 
additional proof of the existence of prostatitis, may be obtained 
by introducing the finger into the rectum. If the gland is in- 
flamed it will be much larger than usual and will be very pain- 
ful on pressure. The passage of a sound also produces great pain, 
in cystitis as well as in prostatitis. Then again the ammoniacal 
odor of the urine is a guide to us in cystitis, as well as the pain 
on pressure over the hypogastric region, the passage of a sound, 
etc. A microscopical examination shows the presence of epi- 
thelial and pus cells. 

Chylous urine is of rare occurrence, intemperate or northern 
latitudes. It is more frequent in tropical climates. It arises 
generally from some disturbance of assimilation by which 
the chyle passes unchanged into the urinary tract. Chylous 
urine looks as if mixed with milk. The new ingredient coagu- 
lates on cooling, and soon after separates into two portions, viz : 
fibrin and fat. If allowed to stand for a short time the fat col- 
lects on the surface of the liquid. Under the microscope fat 
globules are seen in large amount but no spermatozoa. 



MECHANISM OF ERECTION. 51 

MECHANISM OF ERECTION. 

In order to treat a case of spermatorrhoea or impotence suc- 
cessfully, we must understand all the varied elements that are 
concerned in producing the normal as well as the abnormal 
erection of the penis. Specially must we examine the nerve 
centers which are supposed to govern the genital or procreative 
function. Very little, it is true, is known about them, but that 
little may guide the conscientious student in the right direction 
toward further development and new discovery. Gall, the cele- 
brated phrenologist, located the governing power of the sexual 
instincts in the cerebellum or " little brain." Removal of the 
organ sometimes produces atrophy of the testicles in the male 
and of the ovaries in the female. When it is removed from the 
rooster, and the bird is placed with his family of hens, he will 
attempt to perform his functions as usual, but in vain, He is 
unable to co-ordinate his muscular movements for the act, 
though there is every evidence of desire being still present. 
This experiment shows only that the cerebellum has a govern- 
ing power over the co-ordination of our muscles. Tumors of 
the cerebellum, and clots of blood in the same organ, have 
produced satyriasis in the male and nymphomania in the female. 
A patient under my treatment had an emission whenever the 
barber shampooed his occiput. Other cases of a similar nature 
are recorded, but they prove nothing absolutely, because the 
barber's brush at the occiput covers other nervous structures, 
such as the medulla and the upper cervical nerves. Besides 
all these cases occurred in persons who had masturbated ex- 
tensively, thus rendering the nerves exceedingly sensitive, and 
any pleasureable irritation applied to other parts ot the nervous 
system might have produced a like result. 



52 MECHANISM OF ERECTION. 

In Kirke's handbook of physiology, M. Flourens says ; 
" There is no proportion between the size of the cerebellum and 
the development of the sexual passions. On the contrary, 
many instances may be mentioned in which a larger sexual ap- 
petite co-exists with a smaller cerebellum, e.g., rays and eels, 
which are among the fish that copulate, have no lamina on their 
almost rudimental cerebellum, and codfish, which do not copu- 
late, but deposit their generative fluids in the water, have com- 
paratively well developed cerebellums. Among amphibia, the 
sexual passion is apparently very strong in frogs and toads, yet 
the cerebellum is only a narrow bar of nervous substance. 
Among birds there is no enlargement of the cerebellum in the 
males that are polygamous ; the domestic cock's cerebellum is 
not larger than the hen's, though his sexual passion must be es- 
timated at many times greater than that of the horse. Among 
mammaha the same rule holds good, and in this class the ex- 
periments of M. Sassaigne have plainly shown that the abolition 
of the sexual passion by the removal of the testicles early in life 
is not followed by any diminution of the cerebellum, for in 
mares and stallions the average absolute weight of the cerebel- 
lum is 6 1 grains, and in geldings 71 grains, and its proportion- 
ate weight compared with that of the cerebrum is on an average 
as i: 5-57 in mares ; as i : 5-97 in geldings, and only as i : 7- 
07 in stallions. On the whole therefore it appears advisable 
to wait for more evidence before concluding that there is any 
peculiar and direct connection between the cerebellum and the 
sexual instinct or sexual passion." 

There is another portion of the nervous system which also 
has some direct influence over the genital apparatus. It is lo- 
cated in the spinal cord, in the dorso-lumbar region. Various 
kinds of irritants applied at this point affect the genital organs 



MECHANISM OF ERECTION. 53 

in both sexes. An electrical current sent through will cause 
contraction of the bladder, retraction of the testicles, and some- 
times erection of the penis. In the female it excites contrac- 
tions of the uterus, vagina, and bladder. If the dorsal nerves 
of the penis are cut erections will not be maintained until the 
cut ends are again joined. This operation is sometimes 
performed in order to render stallions impotent. 

Under healthy conditions every ejaculation of seminal fluid 
is accompanied by an expansion of the erectile tissue of the 
penis, and by a pleasureable sensation, known as the orgasm. 
Some think that the peculiar sensation arises from a distension 
of the veru montanum, a raised ridge of mucous membrane in 
the prostatic urethra, which has been previously described. 
This body is highly sensitive, and when distended prevents the 
regurgitation of seminal fluid into the bladder. It is very proba- 
ble that the distension of the ejaculatory ducts when the semen 
is passing, may influence the orgasm quite as much as the dis- 
tension of the veru montanum. The erectile tissue, like every 
other vascular tissue in the body, is under the direct control of 
the sympathetic nervous system, a control which is entirely in- 
dependent of the will, and influenced solely by the emotional 
nature. An excellent illustration of this is seen in the simple 
act of blushing. An emotion of a certain kind acting through 
the sympathetic nerves will cause the capillary bloodvessels of 
the cheek to dilate. They become distended with blood, and 
cause the warmth and reddening, which is called a blush. An 
emotion of a contrary nature will cause contraction of these 
bloodvessels, and a resultant paleness. 

In like manner, uninfluenced by the will, certain emotions 
which it is not necessary to enumerate, will produce a dilatation 
in the bloodvessels of the penis, and expansion of the erectile 



54 MECHANISM OF ^ERECTION. 

tissue, and an active determination of blood to the corpora 
cavernosa and corpus spongiosum, which causes a physiological 
erection. The permanency of the erection depends first on the 
increased afflux of blood to the parts ; second, upon tonic con- 
tractions of muscles connected with the penis, and third, a certain 
amount of obstruction to the return circulation from the organ. 
The muscular fibres of the accelerator urinae take an active 
part in this partial and physiological obstruction. Its middle 
fibres compress the erectile tissue of the bulb of the corpus 
spongiosum, and the anterior fibres compress the dorsal vein of 
the penis during erection. The fibres of the erector penis com- 
press the corpora cavernosa during the contraction. In this 
connection we must not lose sight of the fact that the invol- 
untary muscular fibres of the erectile tissue of the penis take an 
active part in the erection of the organ, and lack of tonicity in 
these muscular fibres, as well as in the voluntary muscular 
fibres, is one of the principal causes in impotence. 

Many physiologists deny that there is any obstruction to the 
return circulation ; that such obstruction is not necessary to the 
permanency of the erection. They say further that the erec- 
tion is maintained simply by an increased supply of blood to 
the organ, and consequent distension of the erectile tissue. It 
is an undisputed fact, that the muscles mentioned are con- 
tracted during erection, and that irregular spasmodic contrac- 
tion of these muscles will interfere with the erection, that is, 
diminish its power. From their situation and attachments it is 
impossible for them to contract without compressing the veins 
bringing blood from the penis, as well as the erectile tissue of 
the corpora cavernosa and corpus spongiosum. Without this 
interference with the current of blood coming from the organ 
the blood would be forced out of it during intromission. 



MECHANISM OF ERECTION. 55 

The erectile power is often lost in enervated individuals by 
the relaxation of these muscles, or by their spasmodic action. 
Indeed I regard this lack of contraction as entering largely 
into the causation of impotence. In this connection, it will 
perhaps be well to examine the views of other authorities on 
the subject. Kobelt says : " Thus on the one hand the glans 
penis, endowed as it is with sensibility, and on the other hand 
the irritable muscular apparatus of the bulb, act and react 
upon one another as reciprocal exciting causes. The glans 
penis when excited reacts on the bulb, which sends more and 
more blood, the exciting material, towards it. Each new rush 
of blood to the glans penis exalts its sensibility, the bulbo-cav- 
ernous muscle, irritated in its turn, progressively accelerates 
its contractions, in order to satisfy the requirements of the 
glans, which also increases more and more till at 
last, by alternate actions, the entire apparatus reaches its 
highest point of excitement. At this moment a new series of 
secondary reflex phenomena are suddenly produced between the 
glans penis and the muscles which produce evacuation of the 
vesiculae seminales, these muscles become excited, a spermatic 
ejaculation is produced, and at this point the currents ex- 
change, the special function is accomplished and the organ, as 
soon as nature has gained her end, returns to its ordinary state 
of repose and vegative life." 

" Erection is caused by a relaxation of the muscular elements 
in the trabeculse of the cavernous and spongy 'bodies, and of 
the tunica media of the arteries of these parts, in consequence 
of which the tissue, like a sponge which has been compressed, 
expands and becomes filled with blood. The rigidity ensues 
so soon as the muscles are completely relaxed, and the sinuses 
filled to the utmost, without thejre being any necessity that the 



56 MECHANISM OF ERECTION. 

return of blood should be impeded and the circulation stopped. 
It ceases when the muscles again contract, the venous spaces 
become narrowed, and the blood is expressed from them." 
Rouget says : " The distention of the vesiculse seminales is the 
first cause of natural erection. The latter commences by a 
species of spasm, which develops itself in the muscular appa- 
ratus of the generative system, is transmitted de proche en 
proche to the bundles of the root of the cavernous body and 
the bulb, and tends to propagate itself to the whole extent of 
the penis. The obstacle to the course of blood in the veins 
of the plexus of Santorini, imposed by the first muscular con- 
traction, has for its immediate effect the dilatation of the areola 
of the cavernous bodies by the blood, and the tension of the 
liquid by the blood struggles energetically against the muscular 
tonicity up to the moment when ejaculation being accom- 
plished, spasm ceases little by little in the same situations 
where it began ; the circulation then becoming free, muscular 
contraction gets the better of the tension of the blood, and 
partially drives on the liquid. The organ then itself gradually 
resumes its natural dimensions." 

In this connection, the following peculiar case of partial 
erection is of interest : Two years ago I was consulted by 
a gentleman who had been a sufferer from chronic gonorrhoea 
and stricture for a long period. He said that for five years his 
erections had not been complete, as only the upper part of the 
organ partook in the distension. The corpus spongiosum 
seemed to take no part whatever in the erection, and the organ 
when erect was flat. He said his penis seemed flat whenever 
erect. There was no lack of strength in the patient. His 
emissions were not too frequent, and in other respects seemed 
to be natural. The only thing that troubled him was the pe- 



MECHANISM OF ERECTION. 57 

culiar shape of the penis, when expanded. I saw him again 
six months ago, but there had been no change in the character 
of the erections and he had no difficulty in sexual intercourse, 
or any lack of pleasure therein. 



CHAPTER IV. 

SPERMATORRHCEA AND IMPOTENCE. 

What Constitutes Spermatorrhoea — Opinions of Hippocrates, Celsus, Lalle- 
mand, Acton, Van Buren, Hamilton, Bartholow, McGraw, Gross, Post, 
Hutchinson, and others — Various causes of Spermatorrhoea and 
Impotence — Masturbation, Sexual Excesses, Mental Emotions, Conti- 
nence, Diseases of nerve centers, diseases of Testicle and Penis, Congen- 
ital and acquired Malformations — Relative Indulgence in the Vice of Mas- 
turbation by Inhabitants of Savage and Civilized Countries — Masturbation 
among Animals — Age at w^hich Onanism is usually begun — Nurses as 
Teachers of Immorality — Dangers of Intimate Companionship — Influence 
of certain Gymnastic Exercises in Developing Masturbation — Varieties of 
Exercises that should be Prohibited — Cases in which Swinging from Poles 
and Bars should be Prohibited — Morbid changes in the Genital Organs 
caused by Self- Pollution — Constitutional changes from the same cause — 
Why Seminal Emissions continue when Masturbation is discontinued. 

Spermatorrhoea, or Spermatozemia, is a disease characterized 
by involuntary discharges of seminal fluid. The name in its 
strictest application is confined to those rare cases in which 
ejaculations of semen occur without desire, sensation or excite- 
ment. Modern usage, however, has made the term applicable 
to all cases of involuntary seminal discharges, which occur with 
such frequency as to produce a perceptible deviation from a 
healthy state. 

Impotence, or loss of power to copulate, is usually an accom- 
paniment of spermatorrhoea. They rarely occur separately. 
Exciting and predisposing causes of the one are exciting and 
predisposing causes of the other. The etiology and treatment 
of both are the same. Their consideration, therefore, under 
the same general head, will be more advantageous to the reader, 



SPERMATORRHEA AND IMPOTENCE. 59 

than if a symptom, such as impotence really is, were studied in 
another chapter. 

Spermatorrhoea has been recognized from the earliest antiquity. 
The oldest writers gave it ample space and consideration. Every 
manifestation of the affection has been studied for nearly two 
thousand years, yet there is still a wide difference of opinion 
as to what constitutes a true case of spermatorrhoea. This is 
well illustrated by the following extracts from published works 
and correspondence. Hippocrates called the disease Tabes 
Dorsalis. He says " it proceeds from the spinal cord, and is 
frequently met with among newly married people and libertines. 
There is no fever, the appetite is preserved, but the body falls 
away. If you interrogate the patients, they will tell you that 
they feel as if ants were crawling down the spine. In making 
water or going to stool they pass much semen. If they have 
connection the congress is fruitless ; they lose semen in bed, 
whether they are troubled with lascivious dreams or not. They 
lose on horseback or in walking. Their breathing becomes 
difficult : they fall into a state of feebleness, and suffer from 
a weight in the head and a singing in the ears. If in this condi- 
tion, they become affected with a strong fever, and die with 
cold extremities." Celsus, evidently referring to spermator- 
rhoea, says : 

" There is also a disease of the genital organ, an excessive dis- 
charge of semen, which is rendered without a sexual intercourse 
or nocturnal illusions, to such an excess that in time a man 
may be carried off by consumption." 

Araetius, says " The semen flows away, nor is it capable of 
being suppressed even during sleep, whether the man be asleep 
or awake the discharge is kept up, nor is there any cessation of 



6o SPERMATORRHCEA AiSTD IMPOTENCE. 

Galen thought that constant and involuntary discharges of 
semen constituted gonorrhoea. In fact that was the opinion 
held by many of the ancient writers, and the term gonorrhoea 
means a flow of semen. Moschon says that "gonorrhoea is 
an emission of semen without desire." Rufus of Ephesus 
was of the opinion that " nocturnal emissions, pollutions, 
disordered men more than coitus, because when pollution hap- 
pens to a man oppressed with sleep, and his powers asleep, it 
more oppresses and more affects the man." Sartorius thought 
that spermatorrhoea disposed to calculus, diminished the natu- 
ral heat, and brought on weakening and loss of sight. 

Coming down to later times, we find Ambrose Pare speaking 
of an involuntary flow of semen running from all parts of the 
body to the genital organs, caused by the resolution and paral- 
ysis of the retentive faculty of these parts, and from too great 
an abundance of blood and seminal matter within the body. It 
is probable that he referred to gonorrhoea and not to sperma- 
torrhoea. 

Lallemand says, " I shall express by the term spermatorrhoea, 
every excessive spasmodic ejaculation from whatever cause it 
may arise." 

In Acton's valuable treatise on the reproductive organs we 
find the following : 

" Great exaggeration has doubtless been indulged in by many 
of those who have described the complaint, and this from ob- 
vious and infamous motives, but I am convinced that many of 
the most obstinate complaints which the medical man meets 
with, arise from the repeated loss of semen. The condition or 
ailment which we have characterized as spermatorrhoea then, 
as we shall use the word, is a state of enervation produced at 
l^ast permanently, by the loss of semen." 



SPERMATORRHCEA AND IMPOTENCE. 6l 

Gross says " a loss of semen is one of the natural consequences 
of manhood, it is a necessity of the system, and is therefore to 
be regarded as a disease only when it occurs too frequently, or 
when it is produced by improper means." From this statement 
•it is to be inferred that any seminal losses which affect 
the general health, come under the head of sperma- 
torrhoea. 

Van Buren and Keyes, in their work on genito- urinary sur- 
gery, say " that spermatorrhoea is an escape of seminal fluid con- 
taining spermatozoa, is an escape without ejaculation, and with- 
out pleasurable sensation or orgasm, usually at stool, with the 
urine, or to a slight extent at all times during prolonged erection 
under extreme sexual excitement. A small amount of the semi- 
nal fluid is apt to escape into the prostatic sinus, and to be 
passed at the next erection or urination." 

R. Bartholow thinks the term spermatorrhoea should be 
restricted to that condition in which involuntary losses occur 
with sufficient frequency to produce a well defined morbid 
state. 

Hamilton McGraw, of Detroit, says : " I do not believe that 
even a daily emission of semen will do serious damage to a 
healthy vigorous man." I fear that few physicians of experi- 
ence will be found to agree with this view. 

Dr. Vandeveer thinks that three out of every ten cases of 
so called spermatorrhoea are imagination. 

The vast majority of authorities however agree in the opinion 
that spermatorrhoea and impotence are active factors in a 
development of mental and physical derangements and 
in the transmission of constitutional weakness from 
father to child. The general recognition of this fact has 
not yet been productive of a systematic plan of treat- 



62 SPERMATORRHCEA AND IMPOTENCE. 

ment. Vagueness, uncertainty, and contradiction, abound 
in nearly every system of medication recommended 
Hence, the field is almost monopolized by quacks, who reap 
rich harvests in the management of the disease. 

The causes of spermatorrhoea and impotence, in the order of 
frequency, are : — 

Masturbation. 

Sexual excess. 

Mental emotion. 

Diseases of nerve centers. 

Continence. 

Diseases of testicle and penis. 

Congenital and acquired malformation. 

Diseases of the rectum and urethra. 

Drugs. 

MASTURBATION. 

Masturbation is a universal vice in civilized countries. A 
very large majority of human beings of both sexes indulge in 
the habit from early childhood. 

In savage lands it is of rare occurrence. Savages live in a 
state of nature. No moral obligations exist which compel 
them to abstain from a natural gratification of their passions. 
There is no social law which prevents them from following the 
dictates of their lower nature. Hence they have no reason for 
adopting onanism as an outlet for passions. 

The moral trammels of civilized society and ignorance of 
physiological laws give origin to the vice. The dread of the 
consequences of sexual intercourse begets continuous indul- 
gence in the other sin because it is less liable to be found out. 
But masturbation is not confined to human bipeds. The lower 



SPfiRMAtOkRHCkA AND IMPOTENCfi. 6$ 

order of creation sometimes display lascivious proclivities in that 
direction. Dogs, cats, monkeys, and rats have been known to 
masturbate. Such cases must be exceedingly rare, because the 
opportunities for sexual congress among animals are unlimited. 
Indeed, it is more than probable that the creatures so indulging 
must have been taught the habit by some depraved beings of 
the human species. 

Children commence the habit at a very early age. Cases are 
on record of babes at the breast masturbating. A strong ele- 
ment of doubt necessarily surrounds such records. They 
must be taken cum grano salis^ though the observer may have 
been honest in his belief. It is possible to mistake the ordinary 
spasmodic movements of a delicate child, laboring under undue 
excitement, from worms, or a scrofulous vulvitis, for well di- 
rected efforts at masturbation. It is an authenticated fact, how- 
ever, that children at the breast are often excited by their 
nurses, in order to keep them quiet. The titillation of the 
child's genitals produces sensations of pleasure which allay its 
cries. Thus the seeds of a loathsome disease are often sown. 
With matureryearSjthe recollection of past experience awakens 
in their young breasts an exaggerated venereal sense, and pro- 
longed onanism results as a natural consequence. Often, in- 
deed, the cessation of excitation at the hands of the nurse 
marks the commencement of personal pollution. Children have 
been known to begin the habit at the early age of five. Though 
there are no spermatozoa formed at that period of life — not, in- 
deed, before puberty — emissions and erections are produced by 
the friction. The fluid which forms the emission is probably 
the production of the prostate and Cowper's glands. 

From eight to sixteen may be called the masturbating period. 
At sixteen or eighteen they are apt to be frightened from the 



64 Spermatorrhcea and impotence. 

practice by reading, or hearing from friends, of the mental and 
physical decay which threatens to overtake them. 

At least ninety per cent, of the persons addicted to the vice 
owe their misfortune to the instructions obtained from domes- 
tics or from older and more vicious playmates. Or they are 
taught by erotic nurses in whose care they are placed by con- 
fiding parents. A gentleman of my acquaintance, who for 
years suffered from the consequences of onanism, informed me 
that his first experience occurred between five and six years of 
age. The nurse, who slept in his room, carried him one night 
to her own bed, and gave him his first lesson in the art, a lesson 
which cost him years of feeble health, anxiety and pain. His 
case is only one in thousands. It shows that the character and 
habits of the nurse and domestic have often more to do with the 
future welfare of the child than the character and habits of the 
parents. All nurses, good, bad, and indifferent, need watch- 
ing. And in order to determine whether the children have 
been tampered with or not by the nurses, a critical examina- 
tion of the genitals should be made from time to time. Fric- 
tion of the genitals soon manifests itself by looseness of the 
integumentary covering of the penis in the male' and of the 
labia in the female. In females the redness is the principal ef- 
fect noticed, though a large amount of the normal mucous se- 
cretion is generally also present. In aggravated cases the se- 
cretion may be muco-purulent. It must, however, be borne in 
mind, that in scrofulous children there is often present a leucor- 
rhoea entirely independent of masturbation, but the consequent 
irritation of which often gives rise to the habit. 

It has been suggested that a rigorous law on the statute book, 
with a fitting penalty attached, would deter, if it did not com- 
pletely stop, depraved nurses from transferring their lewdness 



SPERMATORRHCEA and IMPOTiENCE. 65 

to the innocent minds of the children under their charge. A 
few examples of punishment might be of benefit to the rising 
generation. 

As a rule it is wrong to allow children to sleep in the same 
room with their nurses, or in the same bed with other children. 
Nor should they be allowed to frequent lonely places or be 
away from the observing eye of a watchful tutor or friend. 
The natural curiosity of children, combined with the animal 
instinct for sexual pleasures, leads them to an examination 
and finally to a titillation of their genital organs, often without 
the aid of any vicious instruction. 

There are certain gymnastic exercises provocative of mastur- 
bation. These exercises are common in all gymnasiums, and 
in many school grounds. My attention was first called to this 
subject by the history which a confirmed masturbator gave me 
of his first experiences. He entered school at the age of 
seven. The day after his admission he visited the school gym- 
nasium. His attention was attracted to the swinging pole 
around which a number of boys were enjoying themselves. 
He took hold with the rest, sustaining the whole weight of the 
body by the hands, swinging himself around the circle for 
some time. In a few minutes he had such peculiar sensations 
about the genitals that he was forced to discontinue the move- 
ment and rest. Again and again he swung himself around 
until he experienced the same effect, the sensations becoming 
more positive and intense. The next day, on trying the same 
experiment, the tingling sensations terminated in an orgasm. 
This led him to a closer examination of his organs, and also to 
new methods of increasing the same excitement, until finally 
he became a confirmed masturbator. 

Another, a patient now under treatment, said that the first 
5 



66 SPERMATORRHCEA AND IMPOTENCE. 

time he ever felt pleasurable sensations in his genitals, was 
while he was engaged in sliding down the mast of a whale 
boat. The first repetition of the exercise produced an orgasm, 
and from that grew the habit for which he was under treat- 
ment. A somewhat similar history has been given me by 
others, one a female, who learned the art by sliding down the 
stair-bannisters. Lallemand relates the case of a boy who 
commenced masturbating by straddling down transverse bars, 
and another who excited himself while hanging by the arm and 
thus sustaining the whole w^eight of the body. So numerous 
are such cases, related by experienced men, that there can be 
no doubt of the injurious results of such exercises, nor of the 
salutary effects which would arise from their prohibition. 
Gymnastic exercise, such as climbing, sliding down poles, 
clinging to rings, bars and ropes, swinging by the hands, in 
fact every exercise in which the whole weight of the body is 
sustained by the hands, should be excluded from school gym- 
nasiums. Boys under eighteen should not be allowed to 
indulge in any gymnastic exercise tending to produce a deter- 
mination of blood to the genital organs. After that age there 
is less likelihood of producing evil from these peculiar gymnas- 
tics. There are many occupations which, after puberty, are 
apt to produce the habit of masturbation. Boys and young 
men who are confined all day in stores and factories, who use 
tobacco or alcohol, and take little or no exercise out doors, 
are liable to become victims. Erotic tendencies and inordi- 
nate irritability of the genital organs are fostered by confine- 
ment and sedentary habits. Boys out of doors, breathing pure 
air, in active employment, rarely indulge in the vice or con- 
tinue it to their injury. Onanism, developed after puberty in 
persons of sedentary habits, is more pernicious in its effect 



SPERMATORRHCEA AND IMPOTENCE. 67 

than when it is commenced in early childhood. The repeated 
nervous shocks which it occasions are stronger, and make a 
deeper impression on the system. The individual becomes 
more wedded to the vice, and is more likely to persist in his 
transgression than those younger patients who, with the first 
dawn of manhood, have been warned of the evil consequences 
of the habit which they commenced, before their reasoning 
faculties controlled them. 

Masturbation, though injurious to both sexes, is less so to 
females than males. The worst features of the vice are always 
more apparent in the latter from an equal amount of indul- 
gence. Girls hide most of the ravages of the vice under 
" general nervous excitement ; " boys have not this convenient 
refuge. It is generally supposed that every masturbator carries 
his sign out, and that the face is a never failing tell-tale. Such 
is not invariably the case. The majority of masturbators 
show no more signs of the secret vice than married men do of 
free sexual intercourse. It is a great mistake not to make a 
diagnosis because the often detailed signs are not perceptible in 
every feature. There is always difficulty in getting at the 
truth from patients when the external signs and manifestations 
are not prominent, because positive denials of the practice are 
almost always made. And it is a good rule to disbelieve these 
denials, unless a local examination confirm their statements. 
It is only when the sin has been a besetting one for a long 
period of years, and when it has destroyed many of the finer 
instincts of manhood, that you notice the characteristic 
pale expressionless face, with sunken eyes, that seldom meet 
yours, but steal sidelong glances, when your attention is drawn 
in another direction. Only in such chance chronic cases do 
we find the patients cowardly, easily startled, sleepless, inani* 



6% SPERMATORRHCEA AND IMPOTENCE. 

mate, forgetful, stupid, troubled with vertigo and epilepsy, 
mere animals in everything, — in desire, as well as in action. 
We rarely meet with such cases, because the years of discre- 
tion bring an appreciation of the danger, that either diminishes 
or permanently stops indulgence in the vice. As before stated, 
this change is likely to occur about the age of eighteen, at 
which time too the local effects are plainly evident to the per- 
sonal observation of the patient himself, and these too add to 
the fears and assist the attempts at reformation which generally 
are successful, unless indeed he is completely controlled by un- 
governable and beastly sensuality. Though the effects of 
years of masturbation may not stamp itself indelibly on the 
features, or remarkably impair the general health, at least so 
far as the uneducated can discover, yet there are characteristic 
marks on the genitals which cannot be mistaken. The local 
lesions are sufficient for a diagnosis, even where no correct his- 
tory of the case is obtainable. 

LOCAL EFFECTS OF MASTURBATION. 

The penis is thinner and smaller than usual. It is often 
elongated, and cold to the touch at different points. The glans 
is much larger than the rest of the organ; this enlargement of the 
glans is due to the frequent handling, to the relaxed condition of 
vascular spaces in the erectile tissue, and the gravitation of 
blood to the most dependent portion of the organ. The veins 
of the integumental covering are dilated and varicose. In many 
patients the penis is bent laterally, and the inclination is gener- 
ally toward the left side; this condition is probably due to 
partial paralysis of the muscular fibres of the opposite side. I 
have sometimes in such cases found the opposite or convex 
side deficient in sensibility. Nearly all persons suffering from 



SPERMATORRHCEA AND IMPOTENCE. 69 

the effects of masturbation or excessive sexual congress, present 
this peculiar change in the shape of the organ. The deformity 
is more apparent in those who commence the habit before 
puberty. 

The scrotum is also relaxed and elongated. The testicles are 
small and soft, and the left one hangs much lower than it does 
in health ; sometimes they are extremely sensitive, and very 
slight pressure gives rise to pain. The sensitive testicle may 
atrophy, and it is generally smaller than the other. An enlarged 
and varicose condition of the veins of the spermatic cord is 
present in many cases. 

The mucous membrane of the urethra is injected throughout, 
but the greatest amount of congestion is to be found in the 
prostatic portion of the urethra. The morbid changes are here 
very well marked. The mucous membrane lining this portion 
of the canal is intensely congested and swollen, but in the lower 
part the changes are more extensive. The lining membrane is 
thickened by the formation of new connective tissue, and in- 
filtration of cells ; it is of a dark red color, and has lost much 
of its epithelium. The veru montanum, whose distension 
during coitus causes the orgasm and prevents the semen from 
going backwards into the bladder — is increased to twice its 
ordinary size. Indeed it is often so large as to afford an ob- 
stacle to the passage of the sound. Its sensitiveness is usually 
increased. In very bad cases where there is absolute paralysis, 
sensation in it may be entirely absent — but as a rule it is exag- 
gerated. Patients complain constantly of an itching or tingling 
sensation in the part which seems to them like a commencing 
orgasm, and that sensation may be increased by very little 
excitement, so as to terminate in an orgasm. The mucous 
lining of the prostatic urethra, and of that portion of the mem- 



70 SPERMATORRHCEA AND IMPOTENCE. 

brane of the bulb near where the ducts of Cowper's glands 
empty, presents very much the same appearance as granular 
lids do in long standing cases. The orifices of the prostatic 
ducts, which line each side of the veru montanum, are much 
larger than usual, are darker colored than the rest of the mucous 
membrane, and, like the other parts, divested of epithelium. 
Their mouths may contain a quantity of muco-purulent exuda- 
tion. Sometimes there is ulceration at the orifices of these ducts. 
The mouths of the ejaculatory ducts which open near the edge of 
the sinus pocularis, present similar changes. With regard to 
this fact Lallemand says : 

" The ejaculatory ducts generally share the alteration and 
dilatation of their orifices, besides which, they may be insulated 
as though distended, by the suppuration of the prostate, or thick- 
ened, hardened and cartilaginous, or they may even contain 
osseous granules. These alterations, much more serious than 
those of the orifices, must dispose very much to the involuntary 
escape of semen, the ducts, having lost their elasticity and even 
their power of contraction, are no longer able to drive back the 
semen into the seminal vesicles ; or at least they are incapable 
of retaining it, however gently these reservoirs may contract 
or however little they be compressed ; the pressure exerted on 
these ducts by the swelled tissue of the prostate may cause their 
atrophy or obliteration, whence, of course, ensue the more or less 
complete loss of their functions. 

" The vesiculae seminales may be dilated and thickened ; they 
may lose their characteristic irregular, uneven surface, and be- 
come firmly adherent to the surrounding structures. Their 
lining membrane maybe covered with lymph or granular fun- 
goid vegetations. They may be filled with pus or tuberculous 
matter. I have almost always found in the vesiculae seminales, 



SPERMATORRHCEA AND IMPOTENCE. 7 1 

particularly at the bottom of the depressions, a thick granular 
shining liquid, variable in aspect, color and consistence, but 
resembling pretty thick glue, and more or less transparent. 
Under a power strong enough to observe the spermatozoa, the 
particles {grumeaux) of this secretion appear somewhat irregu- 
lar in size, more or less opaque, and of a uniform shape. These 
are evidently the products of the internal membrane of the 
vesiculae seminales ; for they are found with analogous char- 
acters in the accessory vesiculae of the rat, etc., which never 
contain animalcules, and do not directly communicate with the 
vas deferens. These canals never contain similar bodies in any 
species. This secretion, then, is analogous to that produced by 
the prostatic follicles, Cowper's glands, etc. Its use is the same 
and it deserves for many reasons our special attention." 

The prostate gland is enlarged and tender on pressure. This 
enlargement may remain when other vestiges of the diseased 
action have altogether disappeared. Pressure on the gland 
through the rectum, may or may not be painful, but is usually 
followed by the appearance of an opaque fluid at the orifice of 
the urethra, either immediately following the pressure or at the 
next act of urination. It is composed of prostatic secretion, 
pus and epithelial cells. The passage of a sound over these 
parts occasions considerable pain. When drawn out it may 
be followed by the same opaque discharge as that produced by 
pressure on the prostate, or by a discharge of clear viscid 
mucus. Patients in this condition micturate very frequently 
and the act is rarely accomplished without some sense of dis- 
comfort at the neck of the bladder or rather at the prostatic 
portion of the urethra, when the passage of the urine irritates 
the sensitive and abraded mucous membrane. 

The local changes in the female genital organs always demon' 



72 SPERMATORRHCEA AND IMPOTENCE. 

strate plainly enough the results of masturbation, even when the 
patient denies the habit. The labia minora are elongated. In 
some cases the pulling to which they have been subjected in- 
creases their size to an enormous extent. I have known them 
to measure two inches and a half in breadth and to look very 
much like the ears of a spaniel. They are dark colored at the 
edges, and sometimes are like parchment to the touch. At 
the base they are red and swollen. The clitoris is also elon- 
gated and thicker than in health. In some cases it loses its 
ordinary sensitiveness, at others (and these are in persons who are 
comparatively new to the habit) there is a remarkable increase in 
the sensitiveness. Near the entrance to the vagina there is in- 
tense redness, and in spots excoriation, and these parts are 
sometimes bathed in a muco-purulent secretion. The ducts 
of Bartholin's glands which open in front of the hymen are much 
enlarged. A digital examination is certain to increase the 
normal secretions, and produce turgescence of the clitoris and 
nymphae. 

CONSTITUTIONAL CHANGES. 

As before remarked it is not often that the patient shows un- 
mistakable signs of onanism in the features. It is only in cases 
where the habit has been long practiced, and where the natural 
manhood or womanhood of the individual has been subverted 
by lasciviousness, that we notice marked changes there. In 
other things tlie effects are plain enough to the experi- 
enced eye. The superficial veins of the integument covering 
the hands and feet on the dorsal aspect, are very much enlarged 
or dilated. This is a normal condition in some thin skinned 
people, advanced in years, but when noticed in young persons 
it is C(.nnected with sexual excesses, or masturbation. The 



SPERMATORRHCEA AND IMPOTENCE. 73 

hands are often moist and clammy. While the patient is sit- 
ting, his shoulders stoop, and both hands are generally placed 
on the inside of the thighs. The muscles are flabby ; the face 
is usually pale and sallow. Under the eyes there are heavy 
dark circles. In women, this is a normal condition when 
pregnancy exists and also in persons who have indulged in in- 
tercourse to excess. In uterine diseases it is likewise present. 
In severe cases the eyes lose their firm expression and are luster- 
less, and they rarely meet the gaze of friend or physician. 
Emaciation is often present. The gait is "draggy," as if a 
weight were attached to the heels. Acne is frequently present 
on the face, giving it a disgusting appearance. It is found gen- 
erally in patients with a dark complexion. But it must be re- 
membered that the erruption often occurs independently of 
lascivious indulgence. 

The alimentary canal suffers like the rest of the body. The 
tongue is coated ; constipation is almost always present, due 
to lack of tone in the muscular coat of the bowels and deficient 
secretion. Acid eructations and a feeling of weight in the 
stomach after eating appear with the constipation. In short, 
all the symptoms of indigestion or dyspepsia may be present. 
Vertigo is a common and a very troublesome symptom to deal 
with. It is often accompanied with headache. Sleeplessness, 
with nervous twitching of the muscles, especially those of the 
extremities, and palpitation of the heart are common accom- 
paniments of sexual as well as of solitary indulgence. There is 
general lassitude and an inability to apply the mind to continuous 
work. Memory is deficient, and there is a general incapacity 
for any kind of mental labor. At this time too, certain diseases, 
both of mind and body, are apt to be developed and which will 
be considered in another chapter. 



74 SPERMATORRHCEA AND IMPOTENCE. 

SEMINAL EMISSIONS. 

When the patient ceases to indulge in the habit, he will in a 
short time thereafter be troubled with emissions of seminal 
fluid, at night, accompanied by lascivious dreams and sensations 
of pleasure. Erections may accompany the discharge of semen, 
but they are often absent or imperfect. The impressions made 
on the nervous system by constant discharges of seminal fluid 
soon exhibit themselves, in the general symptoms previously 
enumerated, and require the attention of the physician. Lalle- 
mand gives the following curious method of examining for semen, 
which I fear will be of little use in general practice at the 
present day : " I have already stated that on causing patients 
to make water in a bath, the semen passed may be easily 
recognized by means of its globules which whirl about in the 
middle of a cloud of foam toward the close of micturition. From 
what we have just seen it is evident that these globules come 
from the internal membrane of the seminal vesicles. They may 
be wanting in very few cases where the semen has no time to 
acquire consistency ; but their presence leaves no doubt, as to 
the existence of diurnal pollutions, because they can only be 
furnished by the seminal vesicles. On the other hand, I have 
invariably found spermatozoa in the urine of patients who ob- 
served the phenomena in a bath. The same remarks hold good 
when applied to the globules which the urine deposits in cer- 
tain cases of diurnal pollutions, and which have been compared 
by some to grains of bran, others to millet seed, pearl barley, 
etc., according to the size. These globules are perceived as 
soon as the urine is passed ; they are roundish, very soft, and 
do not give any sensation when squeezed under the thumb ; 
they cannot therefore be confounded with urinary salts, which 



SPERMATORRHCEA AND IMPOtENC£. 7^ 

are deposited only when the urine has cooled, have a crystal- 
line form, and give the sensation of a hard body to the finger. 
The vesical mucus is deposited only on cooling and does 
not furnish brilliant granules. As to us its appearance 
is easily determined. I have found animalcules whenever 
these globules appeared in the urine ; and hence it is that I 
have pointed them out as certain signs of diurnal pollutions. I 
have also noticed that in some cases the urine, when held 
against the light, presents in the middle of a flocculent cloud 
multitudes of quite characteristic brilliant points. These are 
smaller and consequently lighter globules than those which in 
other patients fall to the bottom of the vessel. They are 
neither observed in the mucus of the bladder nor in the pros- 
tatic fluid, which alone presents clouds analogous to those of 
diurnal pollutions. Such brilliant points also arise from the 
seminal vesicles, and their presence is therefore an indication 
that the urine contains semen. This I have often verified with 
the microscope. I should, however, warn those who wish to 
repeat my experiments, that it is not in the midst of the floccu- 
lent cloud that the zoosperms are to be sought, but at the bot- 
tom of the vessel, to which they soon fall on account of the 
greater specific gravity." 



CHAPTER V. 

RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 

Sexual Excesses not so injurious as Masturbation — Seminal Losses not un- 
healthy when they occur from natural causes — DiSerences between Local 
and General Effects of Sexual Indulgence and Masturbation — Excess as a 
cause of Spermatorrhcea and Impotence — Mental Emotion as a cause of 
Spermatorrhoea and Impotence — Effects of Emotion in Hysteria — Simula- 
tion of Mammitis, Peritonitis, etc., by Hysterical Patients — Graham's 
Bed for Impotent Patients — Impotence from Fear, Anxiety, Bad Odors, 
Business Troubles, Bad Temper, Unusual Surroundings, etc. — Interesting 
cases of Hammond's and Rouget's. 

The natural fulfillment of every function exerts a beneficial 
influence on the economy. Deleterious effects only mani- 
fest themselves when the bounds of moderation are passed. 
Even when an organ is overworked by natural means there is 
much less harm done the system than there is from excessive 
work in an unnatural direction. Men seldom suffer as much 
from inordinate sexual congress as they do from the same 
amount of self-pollution. The occurrence of seminal ejacu- 
lations three or four times a week from legitimate sexual 
congress will not be felt very much by a healthy man, while 
the same number of losses from masturbation or nocturnal 
pollutions will soon superinduce mental and physical debility. 
Indeed there are many persons in robust health who indulge in 
daily intercourse with impunity, while others with perhaps 
equal stamina, lose flesh from two or three weekly pollutions. 
The reasons for this are obvious. One act is performed in ac- 
cordance with the dictates of nature — the other is subversive 
and degrading. During sexual intercourse the expenditure of 



RESULTS OJ" SEXUAL EXCESS AND MENTAL EMOTIONS. 77 

nerve force is compensated by the magnetism of the partner. 
In all cases, or almost all cases, there is some return of that 
nature, which prevents injury. The masturbator feels that his 
act degrades his manhood, while the man who indulges in 
legitimate intercourse is satisfied that he has fulfilled one of 
his principal natural functions. There is a healthy instinctive 
expression of passion in one case, an illegitimate perversion of 
function in the other. The sexual appetite, like any other appe- 
tite, varies with the individual. The capacity for sexual inter- 
course also varies with the individual. That which would be un- 
pardonable excess for one, would be moderate indulgence for 
another. There is no invariable law for all to observe. But we 
have, nevertheless, an easily followed rule as a guide in this mat- 
ter as in everything else. Whenever sexual intercourse fails to 
produce its tonic effect, when, instead of exhilaration of spirits 
and clearness of intellect, there are depression, weakness, tremu- 
lousness, anxiety and diminished power of concentration, then 
the act is injurious and the intervals between each co-habita- 
tion should be lengthened. If these warnings of nature are disre- 
garded, a disordered condition of mind and body similar to 
that which arises from onanism will soon appear. 

With reference to this part of the subject Lallemand says : 
"When connection is followed by a joyous feeling, bien etre 
general^ as well as fresh vigor, when the head feels lighter, the 
body more elastic and ready for work ; when a greater disposi- 
tion to exercise of the genital organs evinces an increase and 
activity, we may infer that an imperious want has been satisfied 
within the limits necessary for health. The happy influence 
which all the organs experience is similar to that which follows 
the accomplishment of every function necessary to the 
economy." 



78 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 

On the same point Acton says : " Whilst one individual will 
suffer for days after a single attempt, or even from a voluntary 
emission, another will not evince the least sign of depression, 
although the act be repeated several times in succession or on 
several consecutive nights. Still, as a general rule, the act is, 
and ought to be, repeated but rarely. In newly married people, 
of course, sexual intercourse takes place more frequently, and 
hence it happens that conception often fails during the first few 
months of wedlock, depending, probably, on the fact that the 
semen of the male contains but few perfect spermatozoa. In 
such cases it is only when the ardor of the first love has abated 
and the spermatozoa have been allowed the time requisite for 
their full development, that the female becomes impregnated." 

" In some persons the termination of the orgasm is accom- 
panied by an epileptiform convulsion of more or less severity. 
This is succeeded by a great amount of prostration. There can 
be little doubt that such cases inherit hypersensitive organiza- 
tions, the result, in all probability, of great excess in early adult 
life." Acton says, " This is seen in a very exaggerated form in the 
buck rabbit, who, after every copulation, may be noticed to fall 
on his side in a sort of epileptic fit ; the whites of his eyes are 
turned up, he gives several spasmodic twitches with his hind 
legs and lies panting for several moments, until the nervous 
system recovers itself. 

" There are some men in whom this sort of epileptiform 
orgasm takes place every time connection is indulged in. Na- 
poleon I. is said to have been subject to epilepsy, when, resting 
from his great labors, he indulged in sexual intercourse. No 
doubt can exist that deaths which have occurred in houses of 
ill-fame, as well as on the marriage couch, have arisen from this 
cause' acting upon highly susceptible organizations. Entomo- 



RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 79 

logical works abound with cases in which the male dies after 
the act of copulation. The following, which reads almost like 
a romance, may be explained, perhaps, by this epileptiform 
attack killing the frail insect. It is a brief history of the es- 
tablishment and growth of a colony of termite ants, related 
by Burmeister : 

" ' At the termination of the hot season, the young males and 
females quit the nest and appear on the surface of the 
earth, where they swarm in innumerable hosts, and pair. 
The busy workers then convey a chosen male and female 
back into the dwelling and imprison them in the central 
royal cell, the entrance to which they decrease and guard. 
Through these apertures the imprisoned pair receive the nour- 
ishment they require. The male now, as amongst all other in- 
sects, speedily dies after impregnation has been effected ; but 
the female, from this period, begins to swell enormously, from 
the development of her countless eggs, and by the time she is 
ready to commence laying, her abdomen is about 1500 or 2000 
times larger than all the rest of her body.' " 

Impotence usually precedes the spermatorrhoea, as a result 
of sexual excess, though sooner or later the latter accompanies 
it. They are rarely separated. In the majority of cases the 
excess is continued until there is complete inability to copulate. 
The seminal sacs being comparatively empty, there is no other 
symptom. At first the patient notices that his ejaculations 
occur much sooner than they should, often long before there is 
any specially pleasurable sensation excited by the contact. 
Then he rests, or desists from his intercourse for a while, and 
is surprised at the occurrence of nocturnal emissions. He again 
essays sexual congress, and perhaps has an emission before 
penetration occurs. This disheartens him, and he refrains, only 



8o RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 

to suffer again from the emissions. If the impotence continue, 
as it probably will, the semen, which is constantly being manu- 
factured, fills the seminal vesicles, the nocturnal pollutions are 
trebled in frequency, and very soon all the phenomena which 
characterize spermatorrhoea are present, and such phenomena 
must necessarily follow every form of impotence from excess. 
But there are still cases in which spermatorrhoea is the primary 
manifestation. From various causes, — not always from, lack of 
virility, — the individual who has indulged to excess ceases his 
wickedness. The irritation which excess has produced in the 
genital organs keeps up the rapid manufacture of seminal fluid. 
It passes away with the fecal matter, or rather is squeezed out 
from the seminal vesicles by the hardened feces. Horseback 
riding or similar exercise may also occasion the loss. The 
majority of patients who lose their virility through excessive 
intercourse are often in the enjoyment of average health, with 
the exception, of course, of their local trouble. Many of them 
are of robust build, full-blooded and muscular, and their ani- 
malism is at its maximum development. The local paralysis of 
the penis, which brings them first to the surgeon, is the direct 
result of over-work and exhausted nerve force. Few general 
changes are manifested, except in cases of long stand- 
ing. In such cases, the morbid appearances noted will be sim- 
ilar to those which arise from long continued masturbation. 
When patients reach this stage there is more difficulty in 
obtaining good results from treatment than there is with those 
affected from masturbation. Recent cases are always amenable 
to treatment. The surgeon can promise a cure if there are no 
cerebral lesions. 



RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 8l 



MENTAL EMOTIONS. 

The influence of the mind over the body is usually under- 
estimated. We are accustomed to regard the mind as some- 
thing apart from the mechanism of the body, and by so doing 
often fail to correctly appreciate its influence in producing 
physical changes of an abnormal nature. "A powerful imagi- 
nation will create that which it imagines " in a short space of 
time. A new mental creation, without a basis in fact, 
obscures and distorts that which is real. The records of hos- 
pital and private practice show that there is little limit to the 
power of this influence in creating organic changes where the 
nervous system of the patient is abnormally sensitive. In the 
manifestations of that hydra-headed affection called hys- 
teria the fact is fully illustrated. While an interne of Bellevue 
Hospital, a patient suffering from hysteria was placed in a bed 
adjoining another suffering from peritonitis. Twenty-four 
hours afterwards the abdomen of the hysterical patient became 
tympanitic and swollen, and she vomited at frequent intervals. 
In other words she developed all the symptoms of peritonitis 
without having any peritoneal inflammation whatever. She 
was removed to another ward, appropriate medicines adminis- 
tered^ and recovery took place in a few hours. 

A few days after the above occurrence, a patient with inflam- 
mation of the mammary gland was admitted to the same ward. 
The hysterical woman soon, called my attention to the fact that 
her breast was exceedingly painful and swollen. On examin- 
ing the gland, I found that it was indeed larger than the one on 
the opposite side, and it appeared to be tender on pressure. 
Remembering her previous simulation in the same line, she 
6 



82 RESULTS OF SEXUAL EXCESS ANB MENTAL EMOTIONS. 

was removed to another ward and treated with a good shower- 
bath of three minutes' duration. She recovered rapidly. 

Twelve months after she had left the hospital, I was asked by 
the house surgeon to look at a case of inflammatory softening 
of the brain, which was supposed to be rapidly approaching a 
fatal termination. The visiting physician, suspecting a fatal 
result, told the house surgeon to notify him when dissolution 
occurred, so that he might be present at the post-mortem. The 
patient was confined in one of the cells of the institution, and, 
when I entered, was in a dark corner of the apartment. Her 
limbs were flexed on the body, and her muscles were rigid. 
The thumbs were tightly clinched by the fingers. She seemed 
to be in a state of deep coma, and breathed like a person 
approaching death. I moved her a little, so as to let the light 
shine on her face, and to my amazement discovered my old 
hysterical patient who, the year previous, gave so many mani- 
festations of the influence of the mind in developing morbid 
changes. I called her by name, shook her, and by persuasion 
and a little force made her assume a standing position and 
walk around the cell. The cure was completed in a day or two. 

A few years ago I was consulted by a broker who had sus- 
tained severe losses in Wall street, which, while they had not 
made him ill, increased his sensitiveness to an extraordinary 
degree. No matter how insignificant the occurrence might be, 
a deep impression was left, which gave him sleepless nights and 
distressed him during the hours of day. He read in a news- 
paper one morning of a gentleman falling down in a fit on the 
street and dying, and the thought immediately came that it 
would be dangerous for him to go out alone, for fear of a sim- 
ilar fate befalling him. He made up his mind that he could 
not move a step without company. He would not go alone 



RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. S$ 

anywhere, — refused to ride on the cars or in a carriage of any- 
kind, — not even across the street, unless accompanied by a 
friend or servant. This condition had lasted a year before he 
consulted me. I tried by argument to show him that it was 
impossible that any accident such as he dreaded could happen 
to a man with his physique and with his otherwise healthy con- 
dition, but without avail. I finally prevailed on him to leave 
his house without company the next morning, promising him if 
he did so that I would, at 9 a. m., meet him one block from his 
abode. He did come out alone, and I met him as by appoint- 
ment. The same thing was repeated the next day, though he 
was in a state of intense excitement when I reached him. I 
then made him promise to meet me a block further away the 
next day, and at the appointed hour was at the meeting place, 
but I stood out of the way, where I could see him and yet not 
be seen by him when he came out. When he stepped out of the 
house he looked around for a moment hesitatingly, and then 
started with a rapid movement for the place of appointment, 
looking anxiously about for me. When he had accomplished 
about half the distance he suddenly stopped and grasped the 
railing, and if I had not immediately stepped out and shouted 
to him he would have certainly fallen, from fear only, and 
might possibly have suffered seriously. When I reached him 
he was deathly pale; he trembled like an aspen; his hands and 
face were cold and clammy, and his pulse could scarcely be felt 
at the wrist. 

It was only with a great deal of difficulty that I got him safely 
to his room. After that I persuaded him to meet me a block above 
the last place, and continued to meet him daily, each time ex- 
tending the length of his walk alone until he was able to reach 
his office unattended. I subsequently increased his walk to 



84 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 

60th street, two miles from his boarding place, and besides 
which, I induced hira occasionally to ride on the horse car ; 
gradually working him into a better state of mind by develop- 
ing his self-reliance, he finally recovered. 

Dr. Carter relates the following : " A lady who was watching 
her little child at play, saw a heavy window-sash fall upon its 
hand, cutting off three of the fingers ; and she was so much 
overcome by fright and distress as to be unable to render it any 
assistance. A surgeon was speedily obtained, who, having dress- 
ed the wounds, turned himself to the mother, whom he found 
seated, moaning and complaining of pain in her hand. On 
examination, three fingers corresponding to those injured in 
the child, were discovered to be swollen and inflamed, although 
they had ailed nothing prior to the accident. In four and 
twenty hours incisions were made into them and pus was evacu- 
ated ; sloughs were afterwards discharged, and the wounds 
ultimately healed. Now in this case there can be no doubt that 
the mother's emotion was directed, by observation of the 
parts injured, upon the corresponding parts of her own system, 
thus working a change in the circulation or nutrition, sufficient 
to excite acute inflammatory action." 

Mental emotions have a more powerful influence over the 
functions of the genital organs than they have over any other 
functions in the body. No organs respond so quickly to this 
influence. Mental emotion is a powerful factor in all cases of 
impotence connected with sexual excess or masturbation. It 
occasions impotence among married men, as well as among those 
who are single. Even where men have been abstemious, and 
moderate in the indulgence of their passions and entirely free 
from the reproach of onanism, they are subject to impotence 
from mental causes. An exceedingly slight cause operating 



RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 85 

through the mind, may result in its sudden and untimely de- 
velopment. A disagreeable object, a jest out of place, a fit of 
indigestion, troubles in business, family jars, leucorrhoeal odors, 
pre-occupation of mind, unusual surroundings, fatigue, a doubt 
whether the act can be completed, have all been recorded as 
sources of failure in sexual intercourse. Fear, or anxiety, is 
probably the most frequent cause of failure, especially with those 
who have masturbated. Being subject to emissions when not in- 
dulging in intercourse, and knowing them to indicate relaxation 
and weakness, they read pamphlets on the subject and thus 
further increase the fear of failure. Their minds run on the 
mental decay and loss of manhood which arise from impure 
habits, and with this thought torturing the mind, the first at- 
tempt at intercourse necessarily ends unsuccessfully. The first 
failure is a sure precursor of other failures to follow, all due to 
the emotion of fear, and this fear will last and keep up the im- 
potence until relief is obtained from the physician. In connec- 
tion with this temporary impotence, the hourly concentration 
of the mind on the parts disorders the circulation, increases 
the irritation of the genitals, and if spermatorrhoea has not 
manifested itself previously, it will do so at this stage, as the 
result of mental influences and bad habits. Even in persons 
of vigorous health, impotence may result from fear. Impotence 
has been produced in a healthy man by a friend's recital of his 
own surprising failure. The thought of the accident that befell 
the friend occurred at the time of intercourse, and he too failed. 
A married patient of mine, a lawyer, with excellent physique, 
the father of two children, became temporarily incapacitated in 
this way ; reading in a medical journal that impotence might 
attack healthy persons, temperate in all things, and without 
notice, he became impressed with the fear that a similar acci- 



86 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 

dent might befall himself. Curiously enough, the next time he 
attempted intercourse, the fear took complete possession of him, 
and he became temporarily impotent. 

Roland speaks of a gentleman who, while on a visit to the 
country, was seduced by a lady in full walking costume. Dur- 
ing a period of one year, he continued to cohabit with the same 
woman, under similar conditions, namely, she was invariably 
dressed. He finally married an estimable and healthy woman, 
and though in the full exercise of all his mental and physical 
powers, he was unable to begin or even to complete the act. 
Repeated trials ended like the first. His previous intercourse 
with a woman in full dress had disturbed his equilibrium so much 
that he could not complete the act until his wife had her clothes 
on. 

In Hammond's interesting work on impotence I find the 
following : " A married gentleman who, before entering into the 
matrimonial state, had been excessively given to sexual inter- 
course, but who had no reason to think that his powers were 
exhausted, or even materially weakened, found himself on his 
wedding night and for some days thereafter, absolutely incapa- 
ble of consummating the marriage. His wife was a highly edu- 
cated, intelligent, refined and beautiful woman ; he was devo- 
tedly attached to her, and on marrying had once and for all 
given up all the evil associations of his younger days. His 
passions were strong, but as soon as he attempted intercourse, 
the desire, which he had previously entertained, vanished at the 
thought that it was a profanation for a man like him to subject 
so beautiful and pure a woman to such an animal relation as 
sexual intercourse. ' She is too good for me,' he would say to 
himself, ' I ought to have married a woman used to this sort of 
thing, or, better still, have remained single and gone on in the 



RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 87 

old way.' This happened several times, and then, in disgust with 
himself, he paid a visit to one of his former female associates, and 
in a short time satisfied himself that his powers were as good as 
ever. Again he essayed the act with his wife, and again he met 
with disappointment. He had now been married a week, and 
the marriage was still unconsummated. He then came under 
my care. A case like his presented very little difficulty. I re- 
minded him of the fact that in all probability, however pure and 
noble his wife might be, there was no profanation in sexual in- 
tercourse, chastely undertaken ; that she had sexual organs 
which were intended for the performance of certain functions ; 
that these functions were all connected with the propagation of 
the human species ; that there was but one way that I knew of 
by which the species could be propagated ; that she had se- 
lected him for the one man who was to put her in the way of 
fulfilling her office in the grand scheme of nature, and that my 
advice to him was to lower his estimate of her angelic character, 
and to look upon her in the not less worthy light of a woman to 
be treated as other women are treated under like circumstances. 
He left, promising to be less exalted in his appreciation, but the 
next morning he returned with the information that it was no 
use : he had tried his best, his erections were strong and re- 
peated, but as soon as he went further towards the object he 
had in view his desire became utterly extinguished. * She was 
too good, too delicate for an animal like him ; he could not 
desecrate her beautiful body by any such vile act,' etc., etc. 

" From a few words which he let drop, I became convinced 
that the lady was not so platonic a creature as he thought, and 
that if I could have a few words of conversation with her, I 
could probably end the matter to the satisfaction of both parties. 
I therefore expressed a wish to see his wife, and that afternoon, 



88 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 

with his concurrence, called on her at the hotel at which they 
were stopping during their wedding tour to New York. I found 
her to be a very sensible woman, not at all ethereal, but anxious 
to do her share towards relieving her husband from his embar- 
rassing position, of which she only half comprehended the 
character. I requested her to be a little more free in her man- 
ner with her husband than she had yet been, and told her I 
thought that if she pursued that course there would be no 
further disappointment, but that she was not to act as though 
she had received any instruction from me, but rather as though 
she was disregarding what I had said to her. ^The details, of 
course, I left to her own good sense and womanly feeling. The 
plan was eminently successful, as her husband told me with 
great glee the next day. ' She told me,' he said, 'that she did 
not want any doctors about her ; that she could settle this af- 
fair herself.' 'The rest,' he continued, Ss confidential be- 
tween her and me, but, by heaven, it reminded me of old times ! ' 
It is scarcely necessary to add that there was no further 
trouble." 

Another example of the influence of unusual surroundings 
over the genital functions was furnished me by a medical man 
who consulted me about his failing virility. He stated that 
about five years before he had for the first time in his life 
cohabited successfully. Subsequently he attempted the act in 
the day time, while dressed, and found himself impotent. 
Being of a determined disposition, he continued his attempts 
under the same circumstances, and with the same results. He 
had no hope of recovery and was completely broken down in 
mind on account of his repeated failures. On examining his 
genital organs, I found no sign of abuse or relaxation. He 
denied all excesses. I ordered him to abstain from any attempt 



RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 89 

for some weeks — to travel, and to occupy his mind with other 
subjects, and I advised him at the end of this probationary- 
period to marry, as I considered him perfectly competent to 
indulge his sexual organs in a legitimate manner. He took my 
advice, married, and found no difficulty in sexual congress. 
Two months subsequent to his marriage he attempted cohabit- 
ation with his wife when dressed, and failed as he had in the 
beginning. This second mishap compelled him again to seek 
advice. Feeling assured that it was only the difference in 
surroundings which caused his failure, I told him to dispense 
with all experiments of the kind mentioned, and only indulge 
his venereal sense in the seclusion of the chamber, and without 
the accompaniment of dress. Since he confined himself to this 
rule, he has had no further trouble. It is extremely probable, 
however, that he will always be impotent whenever he has his 
clothes on. 

Grimaud de Caux relates the case of a prominent mathe- 
matician, who married a lady in every way suited to him. 
Both were in perfect health, and desired children, yet at every 
attempt to complete intercourse some abstruse problem would 
insinuate itself into the mind of the professor and destroy at 
once all capacity for the performance of the act, and he was 
compelled to give up the attempt. Again and again the same 
accident occurred. It seemed utterly impossible for him to 
control his mind in the matter of mathematical problems, 
sufficiently long to accomplish anything. The family physician 
finally counselled him to get partially under the influence of 
alcohol and then try. He took the advice, and was enabled to 
reach the desired goal without any further trouble. I recall a 
somewhat similar case, a young professional man who had been 
sued for a large sum of money, that had been used by other 



\ 



90 RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 

people, but for which he was responsible. The thought of his 
unjust debt entering his mind at the moment that he was 
attempting intercourse, rendered him completely impotent. 
And notwithstanding the fact that his erections were perfect, 
he was by this interruption, this mental perturbation, rendered 
absolutely impotent until arrangements had been made to 
remove the debt that troubled him. 

The history of the celebrated quack, Graham, who flourished 
in London many years ago, shows that the influence of mental 
emotion on the functions in copulation was well recognized by 
him. His shrewdness and intuition struck at a most important 
fact, which the scientific minds of the profession of his day did 
not grasp. Graham prepared a richly canopied bed, of large 
dimensions, and with glass legs. He offered the use of this bed 
to persons suffering from spermatorrhoea and impotence, 
guaranteeing perfect success in sexual congress to all who 
made use of it. (Bartholow.) One hundred pounds per night 
was the price charged for its use. The bed proved a brilliant 
success and cured many who considered their virility as hope- 
lessly impaired. 

The mental distress occasioned by a chronic clap, or gleet, is 
often a cause of impotence. A patient of mine, now under 
treatment, always fails if he notices the discharge before retiring. 
Another that I know, is impotent with his own wife, but with 
strange women has no trouble whatever. Another is impotent, 
unless he is able by a powerful effort of the imagination to 
make himself believe that the legal partner of his bed is some 
one for whom he has a stronger feeling. Here, of course, there 
must be an entire absence of that magnetic attraction which 
begets a feeling of desire or attachment and that regard and 
esteem which render marriage endurable — or an uncontrollably 



/ 
/■ 
/ 



RESULTS OF SEXUAL EXCESS AND MENTAL EMOTIONS. 91 

aversion, which working together with other causes produces 
the impotence. 

All physicians who have much experience in the treatment 
of cases of impotence and spermatorrhoea have long ago recog- 
nized the fact that a very large majority are entirely of mental 
origin. No matter what local manifestations of the disease 
may present themselves to the eye of the physician, there is 
always an element of mental influence in the development of 
the impotence which should never be lost sight of. Such cases 
are by some called false impotence. I can see no reason for 
such a name. The impotence while it lasts is real — and it 
often lasts months and years, and indeed may last during a 
lifetime, if not properly treated. And if the cause of it is not 
removed, it certainly will last a lifetime. A division might be 
made by classing them as incurable and curable cases. And it 
must be borne in mind that almost all of the cases can be cured. 

Where the disturbed mentality is a cause of impotence, 
every abnormal or even normal discharge is magnified a hun- 
dred-fold. The disturbed and distorted mental condition reacts 
on the genitals, interfering with their proper blood-supply, 
diminishes the nerve force, and brings into being phases of 
genital weakness. The nocturnal as well as the diurnal emissions 
are increased, and all the mental depression which accompanies 
them. Indeed, were it not for the disturbed mentality which 
these disorders of the genital function excite, physicians would 
have little to do in the way of treatment. The mental dis- 
order is the great obstacle to successful treatment. And though 
the patient may be aware that his disease is imaginary, he 
cannot regulate or command his ideas in the matter, cannot 
bring himself to a reasonable state of mind, no matter what 
advice he receives, until he perceives some diminution in the 
local trouble, procured by therapeutic measures. 



CHAPTER VI. 

DISEASES WHICH RESULT FROM EXCESS AND MASTURBATION. 

Deterioration of the Seminal fluid as Cause of Pulmonary Consumption — 
Changes in the Characters of the Secretions — Hereditary Weakness — 
Why Phthisis develops as a direct result of Masturbation — Phthisis among 
young Married Persons — Erotic desires of Consumptive Patients — Epilepsy 
— Connection of Epilepsy with Onanism — Changes in the Nerve Centers 
as a Result of the Disease — Convulsive Seizures during the Orgasm — 
The Center of Sensation and Voluntary Motion — Irritation of the Tuber 
Annulare causes Convulsions — Termination of Epilepsy or Insanity — Is 
Insanity caused by Sexual Excess and Masturbation — Opinions of 
Various Authorities — Peculiar forms of Insanity arising from these 
Causes — Nymphomania and its causes — Characteristic Cases — Marriage 
and Amputation of the Clitoris as a Cure for the Disease — Satyriasis — 
Curious manifestations of Satyriasis — Aspermatism — Sterility. 

*' The sins of the father shall be visited on the children, even 
unto the third and fourth generation." Nowhere in the cate- 
gory of disease is the truth of this saying so manifest as in the 
case of masturbators. The evil that they do lives long after 
them. Their vicious habits, continued as they are through the 
period when nature is endeavoring to create a vigorous condition 
which will resist the wear and tear of active adult life, leave an 
indelible impress on the , whole structure. All the tissues and 
secretions of the body are affected, and the seminal fluid par- 
takes of the general deterioration. It is thinner, more watery, 
of a pale yellowish white color, and contains fewer spermatozoa 
than it does in a healthy condition. The movements of the 
spermatozoa as seen under the microscope seem to have much 
less activity than the spermatozoa from a healthy, vigorous 



DISEASES FROM EXCESS AND MASTURBATION. 93 

man. Pus and epithelial cells are likewise present in variable 
quantities. This defective seminal fluid is sure to give to the 
foetus the seeds of weakness and decay which are ready to 
germinate with the first exciting cause. There is no more 
potent factor in the development of disease. The child of 
masturbating parents enters the world with vitality so impaired 
that there is a constant invitation to the a^ttacks of every affec- 
tion. The child commences life with a highly organized 
nervous system, morbidly sensitive to every external impression. 
The muscular and osseous tissues are much softer than they 
are normally. I have never yet seen a case of rickets in a^ 
child whose parents did not give some voluntary or involuntary 
evidence of a pernicious habit, or of sexual excess of some 
description. 

The digestive and assimilating organs work feebly, little 
nourishment is taken into the stomach and a portion of that 
which enters that organ passes unchanged through the 
alimentary canal. Dyspeptic symptoms of all kinds are com- 
monly present. The integument is thin and pale, and the deli- 
cate blue veins are easily traced through its transparent surface. 
The lymphatic glands are enlarged and liable to suppurative 
inflammation. The child frets and worries, is generally peevish, 
complains of headache and grows up thin, puny and weak with 
all the tendencies which are said to characterize a scrofulous 
diathesis. 

Many cases of pulmonary consumption are directly traceable 
to the secret sin of the father. It is not so easy to detect the 
mother's share in the results, for the simple reasons that she 
cannot be questioned about the matter at all, and because many 
of the appearances which are found connected with old habits of 
masturbation are also seen in various forms of uterine disease. 



94 DISEASES FROM EXCESS AND MASTURBATlOi^. 

An examination of the labia and vagina of the mother 
when it can be obtained without exciting her suspicions will 
often show the changes due to excessive friction and pulling, 
and establish the amount of responsibility that rests on her 
shoulders for the existence of the disease in the child. I have 
for many years made it a practice to get at the history of the 
parents of consumptive children and my examinations so in- 
variably confirm my suspicions that I have now no doubt what- 
ever of the direct relation between masturbation and hereditary 
phthisis. I know that others in active practice have examined 
and treated such cases and have been able also to trace the lung 
disease to its legitimate origin. But though consumption re- 
sults from the transmitted weakness descending from parent to 
child, it is also developed directly in young men and women 
from long continued masturbation as well as from sexual excess. 
This fact was first brought prominently before my mind by an 
examination of fourteen young patients suffering from phthisis 
in Charity Hospital. Only two gave a positive history of 
hereditary predisposition to the disease. Ten of the number 
acknowledged that they had been addicted to onanism in their 
childhood and had practiced it for years. It was of course im- 
possible to learn anything of the character or habits of the 
parents of these hospital patients, for they were not present to 
be examined, and it is possible that the tendency might be 
transmitted. Since that experience, however, I have repeatedly 
put the question to other sufferers and have accumulated con- 
vincing evidence on the point. I am repeating nothing new 
when I say that those whose nutrition is poor and below par 
are peculiarly liable to attacks of phthisis. One of the effects 
of excessive indulgence is a disarrangement, or, rather, an ex- 
haustion of the nervous system or of the nervous force, from 



Diseases froM excess and MAstukBAxioJt. 9^ 

the successive shocks of the orgasm. Then follow indigestion, 
constipation, (which is only a result of indigestion) and 
lassitude, all tending to impoverish the blood, and the road is 
thus opened for the first bad cold to set up chronic inflammation 
in the lungs, or other forms of pulmonary consumption. 

The erotic tendency of consumptives has been the subject 
of remark by many different authorities. It is mentioned as a 
peculiar phenomenon connected with or caused by the disease. 
The truth is, however, that the erotic tendencies antedate the 
phthisis. They are the direct result of excess, sexual or other- 
wise, and are not the result of the destructive processes at 
work on the lung. Phthisis is the legitimate effect of 
ignorant assaults on the genital organs, carried on through that 
part of the lifetime when the active forces should have been 
devoted to the protection and the development of the rapidly 
growing tissues. Gall relates the case of a consumptive who 
exhibited this tendency in its worst aspects. The patient was 
a married lady who had been the victim of untrammeled de- 
sires. She developed phthisis at thirty and the disease ran a 
rapid course towards a fatal termination. She nevertheless 
curtailed none of her sexual enjoyments. Indeed they seemed 
to grow with the disease, until they became her sole thought 
and care. A day or two before her death while lying in a mori- 
bund condition, unable to move and not able to speak above a 
whisper, with every mark of rapid dissolution about her, she 
importuned her husband to engage again in sexual congress 
with her. The case is a painful but not an uncommon one. 

Professor James R. Leaming of this city thinks " that phth- 
isis, especially of the fibroid variety, is induced by any cause 
which lowers the vitality of the life of the body, expressed in 
the ganglionic system of nerves, and in the blood. Over 



9^ DISEASES FROM EXCESS AND MASTURBATION. 

sexual indulgence and onanism certainly lower the vitality 
greatly and are the more frequent causes of commencing phthisis- 
plastic interpleural exudation in quite young men and women." 
Excessive sexual indulgence often brings about similar 
affections of the lungs, but such cases cannot be traced as 
readily as those arising from masturbation. Many of the cases 
of phthisis occurring among young married people during the 
first year of their new life, are attributable to excessive cohabi- 
tation. Certainly they are frequent enough to give strong pre- 
sumptive evidence that some form of excess is the primal cause 
of the mischief, or at least that some hereditary weakness has 
been assisted by their own over indulgence. Here again is 
another result of ignorance concerning the sexual function, and 
its ultimate purposes in the economy of nature. It is reasonable 
to suppose that even a very moderate amount of information 
concerning the use and abuse of the genitals — even less than 
advised in a previous chapter, would diminish the number of 
these distressing cases in every community. 

EPILEPSY. 

It was noticed many years ago, that patients suffering from 
epilepsy were in the habit of gratifying the venereal sense in 
many curious ways. Their erotic tendencies were developed 
without regard to time, place or circumstances. And it was 
believed that epilepsy, or the same lesions in the nerve centers 
which produced epilepsy, were the prime factors in disordering 
the sexual functions. Further investigation, however, showed 
that the sexual vagaries of the patient existed long befoie con- 
vulsions appeared, preceding them by many years, and that the 
epilepsy of such patients was due to over-excitation of the 



DISEASES FROM EXCESS AND MASTURBATION. 97 

nervous system by the secret vice. Of this there can be no 
doubt. The irritability of the nerve centers is remarkably 
increased in all onanists. Specially is this true of that portion 
of the brain known as the ticber aiinulare^ a collection of gray 
matter in the pons varolii. This point is the great center which 
governs sensation and voluntary motion. Longet says that all 
sensations coming from the periphery to the brain, are con- 
verted into motor impulses through this ganglion. And any 
undue irritation of the part will excite irregular muscular 
movements. 

The abnormal excitability of the medulla oblongata, which 
also arises from the secret habit, is said to be an important 
factor in producing these convulsions. Hammond considers 
that all forms of eclampsia arise from abnormal irritability of 
this portion of the nervous system. Wherever the actual start- 
ing point of the convulsions may be, one thing is certain, viz., 
the condition of the nervous system is such that slight irrita- 
tion from within or without may develop involuntary spas- 
modic contractions of the muscles ordinarily under the con- 
trol of the will. Dr. Baker, of the Cambridgeshire Asylum, 
says, "in seven out of ten cases of chronic epilepsy in the 
male sex, the genital organs are the great sources of excitation, 
and generally from the morbid state in which they are kept by 
the habits of the patient." Dr. Flint relates the case of a 
young lady twenty years of age who suffered from daily epi- 
leptic fits for three years. She stated that the habit of mas- 
turbation was taught her at the age of six, and had been 
indulged in daily until she was sixteen. Afterwards her mind 
was constantly filled with lascivious dreams, and during the 
three years of her epilepsy lascivious dreams attended by an 
orgasm had occurred every night. Baker Brown, of London, 
7 



98 DISEASES FROM EXCESS AND MASTURBATION. 

attributed the cause of epilepsy in young females to the same 
cause, and partially proved his theory by amputating the cli- 
toris of each case coming under his care. The operation was 
remarkably successful, a large majority of his patients making 
a complete recovery after the operation. Some years ago I 
had an epileptic masturbator under treatment in Charity 
Hospital. He foiled every attempt made to prevent him from 
masturbating. The penis and scrotum were blistered, so that 
he could not touch them, but he still managed to complete the 
act by rubbing the perineum with his fingers. His hands were 
tied behind his back, but this also was unsuccessful, for the 
next day he was seen to slide down to the foot of the bed, and 
rub his perineum against the foot piece. He was finally tied 
hand and foot to the bed, so that he could not move a muscle. 
This plan of course could not be continued, and whenever he 
was released in order to change the bed clothes, or to perform 
some other necessary duty, his hands almost instantly sought 
the neighborhood of his genital organs. He was. sent subse- 
quently to an asylum as incurable. 

Serrurier reports an interesting but equally painful case, viz., 
that of a soldier who was the subject of convulsions from sex- 
ual indulgence and masturbation. In the midst of his most 
violent paroxysms he endeavored to excite himself and pro- 
duce an orgasm. This condition lasted six months, when 
death released him from his sufferings. Zimmerman speaks of 
a patient under his care who endured an epileptic convulsion 
whenever he masturbated, or had nocturnal pollutions. Every 
emission, irrespective of its cause, was invariably accom- 
panied or followed by a convulsion. Esquirol mentions the 
case of a young woman of an ardent temperament who became 
epileptic three days after marriage. It was supposed by her 



DISEASES FROM EXCESS AND MASTURBATION. 99 

physician to be a direct result of inordinate indulgence in 
sexual congress. 

Occurrences like these quoted are numerous. Hospital records 
are full of them, and they are not exceptional cases either, se- 
lected to prove a theory for the satisfaction of the originator 
They make up a very large number of the epileptics in all the 
hospitals where such cases receive special care and medical 
supervision. They prove that epilepsy is one of the goals towards 
which all masturbators and libertines are hastening, and one 
which is reached in a very short space of time, when the will 
power to prevent excess is weakened or destroyed. 

CHANGES IN THE CIRCULATORY SYSTEM FROM ONANISM AND 
SEXUAL EXCESS. 

I have already mentioned that dilatation of the superficial 
veins of the extremities is a sequence of long indulgence in 
masturbation and excessive sexual congress. Preceding and 
during the orgasm the respiratory movements are spasmodic 
and irregular, and for a moment are completely suppressed. 
The consequence of this is an obstruction to the current of 
blood flowing towards the thoracic cavity, and a greater gene- 
ral fullness of the veins of the extremities. Such repeated dis- 
tension of the veins as occurs from frequent pollutions becomes 
more and more marked until the relaxed and venous walls 
become permanently dilated. The same effect is produced in 
old age from natural causes, and also from cardiac lesions. 

But it is not the superficial veins only which are thus 
affected- The right side of the heart likewise takes part in 
the morbid process. The dilatation may involve the right 
auricle, and the ventricle of the same side, but generally the 
auricle alone is affected. The dilatation is soon followed by 



lOO DISEASES FROM EXCESS AND MASTURBATION. 

hypertrophy. It has long been remarked that roosters who 
controlled the barnyard are subject to enlarged heart. The 
enlargement has a similar origin to that which occurs in man, 
over action of the heart in sexual intercourse. For like every 
muscular organ in the body which is called upon to do extra 
work, it must increase in size. 

Palpitation of the heart is a troublesome symptom in these 
cases. It must be borne in mind, however, that palpitation may 
be due to simple weakness and nervous prostration, in the same 
class of patients. Slight exercise occasions much shortness of 
breath. Capillary congestion of the extremities especially is 
well marked. The hands are cold and blue, and the pressure 
of the fingers on the integument leaves a white mark surrounded 
by a dark ring which disappears slowly. Acton says : " I have 
seldom met an instance of sexual excess in which com- 
plaint of the heart's action has not been made. Patients as- 
sert that they can make no exertion without suffering under 
palpitation. In order to satisfy myself that these affections of 
the heart were not organic, I have met in consultation most of 
the ablest men in London, and we have come to the conclusion 
that these patients are suffering from functional disease of the 
heart, and consequently the prognosis becomes much less 
serious, provided, as I stated in the preceding, the patients will 
forego these excesses, and treatment is prescribed calculated to 
enable them to gain mastery for their will and to exert self 
control." 

Vertigo is likewise a common symptom. I have noticed 
frequently that the patients subject to vertigo were also 
troubled with fainting spells. Females are more liable than 
males to be affected by syncope. Anemia of the brain from 
weakened action of the heart may cause both syncope and 



DISEASES FROM EXCESS AND MASTURBATION. lOI 

vertigo. (See page 174). Vertigo, however, often arises from 
other conditions such as an afflux of blood to the brain, and 
irregular circulation of blood in the cerebral hemispheres. 

PATHOPHOBIA 

Or hypochondriasis, is associated with disorders of digestion 
in many diseases. Its development, as a result of masturbation 
or sexual excess, is usually co-incident with stomach and in- 
testinal troubles, occasioned by the disturbance of the sexual 
* function. It is rarely absent when the patient has reached 
middle life. The awakening from a self-complacent course 
of sexual enjoyment, is the beginning of the pathophobia. 
Nocturnal pollutions and impotence add to the gloom, and 
suicide often terminates the wretched victim's misfortune. 
Even in mild cases of pathophobia, the patient imagines that 
his disease will certainly terminate in complete destruction of 
mind and body. He shuns his friends and avoids society. 
He distrusts those whose honesty and truth he formerly relied 
on. Business troubles, however slight, haunt his vision sleep- 
ing or waking. A dread of accident or sudden death adds to 
his misery. Every little ache or pain is magnified into a fatal 
affection. He torments his physician with notes of inquiry 
and visits (Flint). To-day he fears consumption, and his 
lungs must be examined ; to-morrow he is certain of heart dis- 
ease, and dissolution is imminent. A headache satisfies him that 
cerebral inflammation or apoplexy has commenced. The stiff- 
joint of rheumatism is all the proof he requires that the use- 
fulness of the limb is forever destroyed. In short, he makes 
day night, sunshine darkness, and gladness sorrow. There is 
no light anywhere. The gloom of the grave is over him. 
And unless relief should come in the shape of judicious advice. 



I02 DISEASES FROM EXCESS AND MASTURBATION. 

or systematic treatment, insanity or suicide will terminate his 
affection. 

INSANITY 

Often follows epilepsy and pathophobia as a result of abuses 
of the sexual organs. The former is more likely to terminate 
in insanity than is the latter. Insanity, however, is liable to 
occur, as a direct result of onanism or sexual excess, without 
the development of either of the above mentioned affections. 
Authorities differ as to the percentage of cases of insanity 
arising from self-abuse. The principal authorities on the 
subject say that ten per cent, of all cases of insanity are 
traceable to masturbation and sexual excess. Deslandes 
states that of two hundred and fifty-six individuals in the 
asylum for the insane at Charenton, forty-four men and three 
women owed their diseased mentality to the same source. 
This statement would indicate that males are affected much 
oftener than females. But it must be remembered that it is 
more difficult to obtain a history of self-pollution from the 
latter than from the former. Much is hidden from the eye of 
the physician, consequently many cases of feminine insanity 
due to the secret vice pass through without diagnosis, and are 
then classed under a different head. Bourgeous, however, errs 
on the other side. He says that the insane at La Saltpetriere 
consist of prostitutes whose insanity originated in debauchery. 
He does not consider that any other elements might enter 
into the development of the disease. A few, at least, of these 
unfortunates must have had remembrances of a nobler and 
purer life. In their better moments the utter hopelessnesss of 
their condition must impress them. They feel then that they 
are forever shut out from home, friends and society, and that 
they are outcasts in every sense of the word. Despair and 



DISEASES FROM EXCESS AND MASTURBATION. 103 

mental anxiety must then be counted as factors in some of 
these cases at La Saltpetriere. Then, again, the effect of al- 
cohol must be taken into account. All these unfortunates are 
addicted to the alcohol habit, and of course must suffer from 
all the mental and physical derangements consequent upon that 
habit. 

Insanity among masturbators is more apt to develop in those 
whose intellectual capacity is below the average, and in cases 
where loss of memory occurs as a prominent feature in the early 
stages of the vice. Persistent loss of memory is always a 
precursor of serious mental disease. Maudsley says, " Self- 
abuse is the cause of a particularly disagreeable form of insanity 
characterized by intense self-feeling and conceit, and profound 
moral disturbance in the early stage, and later by failure of 
intelligence, nocturnal hallucinations and suicidal or homicidal 
propensities." Dr. Ritchie says that these cases chiefly occur in 
members of families of strictly religious education, and those 
who from this cause become insane have generally, to all ap- 
pearance, been of strictly moral life and recognized as persons 
who paid much attention to the forms of religion. As will be 
afterwards more fully stated, it is frequently observed, especially 
in the acute attacks resulting from this cause, that religion 
forms a noted subject of conversation or delusion. "The 
parent, after her son (the only child it may be) is taken to an 
asylum will tell you that his insanity cannot be accounted for. 
He has been so well conducted, so quiet and studious, not 
seeking the company of the gay, the idle and the thoughtless, 
but remaining quietly at home rather than joining the social 
amusements of those of his own age. Further inquiry may 
elicit that he has been of good abilities, and it may be, clever 
in his occupation, that he had few friends and rather shunned 



I04 DISEASES FROM EXCESS AND MASTURBATION. 

« 

the society of the other sex. Had he been other than he was, 
some cause might have been found in the irregularities of life 
to cause insanity in one scarcely beyond boyhood's years ; but 
in such a quiet lad, and so carefully brought up, she is unable 
to suppose a cause. Then she may tell you that for some time 
past a gradual alteration has been going on ; he has changed 
not only in manner but in appearance ; he has become so 
peevish and irritable, so reserved in his conversation, so apathetic 
in manner, so slovenly in dress, so contradictory, and so un- 
certain in his actions, so hesitating, first determining on one 
thing and before he could execute the course determined on 
changing to some other, and has such a want of self-reliance. 
That quite recently, he has grown more and more apathetic, 
more slovenly in dress, paying less attention to cleanliness, and 
become slower in his actions ; that he is now not only irritable 
in his temper, but is at times violent ; that he does things by 
fits and starts, is impulsive, deliberating long and then suddenly 
hastens apparently to carry out his intention, and has become 
so stupid looking and lost, and incapable of taking care of 
himself or his business, and all this has occurred without any 
apparent cause, except it may be his studious habits. At last 
he can be borne with no longer, he is unmanageable in a 
private house and is obliged to be removed from his home." 

" On entering an asylum for the insane, especially if it be 
one receiving patients from the middle as well as from the 
lower class of society, there is one group of inmates which 
may arrest the attention of the visitor from the contrast pre- 
sented to the excited persons around him, on the one hand, 
and to those who are convalescent on the other. Engaged in 
no social diversion, the patients of this group live alone in the 
midst of many. In their exercises, they choose the quietest 



DISEASES FROM EXCESS AND MASTURBATION. 105 

and most unfrequented parts of the tiring grounds. They join 
in no social conversation, nor enter with others into any amuse- 
ment. They walk alone, or they sit alone. If engaged in read- 
ing, they talk not to others of what they may have read ; their 
desire, apparently, in the midst of numbers, to be in soHtude. 
They seek no social joys, nor is any wish for fellowship 
evinced. 

" The pale complexion, the emaciated form, the slouching 
gait, the clammy palm, the glassy or leaden eye, and the 
averted gaze indicate the lunatic victim to this vice. 

" Apathy, loss of memory, abeyance of concentrative power 
and manifestation of mind generally, combined with loss of 
self-reliance and an indisposition for or impulsiveness of action, 
irritability of temper, and incoherence of language are the 
most characteristic mental phenomena of chronic dementia re- 
sulting from masturbation in young men. 

" As in diseases of an exhaustive nature, we find that the 
cutaneous secretion is poured forth abundantly, so in the 
cases occupying our attention the perspiration breaks forth on 
the slightest exertion. This relaxed condition of the perspira- 
tory system is especially marked in the palms, and the exception 
is to find these dry on a masturbator, for generally a damp, cold 
clammy perspiration is constantly present, and makes it par- 
ticularly disagreeable to take the hands of one of these persons. 
The sub-tegumentary layer is but sparingly supplied with fat, 
which is remarkable, considering the little exercise these pa- 
tients, if left to their own guidance, would take. 

^* In acute or recent dementia, the condition of the patient 
is most pitiable. His existence is, for a time, merely vegetative, 
and in well marked cases the obstinacy of disposition is almost 
the only indication of mental action, and the mental origin 



Io6 DISEASES FROM EXCESS AND MASTURBATION. 

of those may be denied. The sufferer becomes quite silent, 
and is lost and unable to take care of himself. He be- 
comes statuesque, and extremely obstinate. He resists pas- 
sively, and occasionally actively. If he be in bed, he will not 
rise to be washed or dressed. If up, he will not retire at 
proper time to bed, or allow himself to be undressed. Every- 
thing requires to be done for him. Cleanliness is neglected, and 
his dress unattended to. He makes no effort to speak, and, 
when addressed, although conscious, does not appear to com- 
prehend what is said. He will not feed himself. Ellis says : 
* Would that I could take its melancholy victims with me in 
my daily rounds (at Hanwell Asylum) and could point out to 
them the awful consequences which they do but little suspect 
to be the result of its indulgence. I could show them those 
gifted by nature with high talents, and fitted to be an ornament 
and a benefit to society, sink into such a state of physical and 
moral degradation as wrings the heart to witness, and still pre- 
serving, with the last remnant of mind gradually sinking into 
fatuity, the consciousness that their hopeless wretchedness is the 
just reward for their own misconduct.' " 

With regard to the tendency to commit suicide, Dr. Ritchie 
says : " The greater frequency of this occurs in those whose 
cases assume a melancholic character with the excitement. 
Although it will be found that various supposed causes may be 
alleged, still I believe that in the greater proportion of such 
cases the immediate exciting cause is the feeling of distrust at, 
combined with alarm for, the consequences of the patient's 
criminal conduct. Hence it is that feelings of their own un- 
worthiness arise in such patients, and under the impression 
that they have committed the unpardonable sin, have sinned 
against the Holy Ghost, and that a future world presents no 



DISEASES PROM EXCESS AND MASTURBATION. 107 

hope of joy or happiness for them, as they are excluded from 
it by their own conduct, they frequently make attempts to ter- 
minate their own existence. Such an act is occasionally in- 
cited by hallucinations of the aural organs, but I have not 
found that suicide is so frequently to be traced to this as in 
other cases of mental aberration depending on other causes." 

Acton says : " In some patients, rash and even criminal acts are 
the result of the idea that an atonement may thereby be made 
for the sin committed. The attempt to injure the genitals and 
similar extravagances often, I believe, arise from such insane 
fancy while, on the other hand, extravagant masturbation or the 
tendency to commit rapes or unnatural crimes may be in some 
cases traced to the not less insane desire the sufferer feels to 
test and to prove to himself or others that he is not im- 
potent." Acton thinks that many of the cases of sexual insanity 
may be cured by appropriate treatment. Dr. Ritchie and other 
authorities give an unfavorable prognosis in all cases. From 
my own investigations I am strongly of the opinion that a per- 
fect cure is impossible, and that when there is an apparent 
amelioration of the symptoms, lasting perhaps long enough to 
buoy the hopes of those related to them, they suddenly return 
to their old condition of hopeless dementia. The cases of 
sexual insanity that have come under my own observation 
have been most difficult to manage. The patients usually have 
lost all moral sense. Their will power has succumbed to the 
most brutal instincts. The drain on their nervous system is 
kept up by nocturnal pollutions. They are consequently not 
amenable to the usual methods of treatment pursued in other 
forms of the same disease. 

Dr. A. E. McDonald says : " In a general way, I may say 
that the two causes of insanity named are much less potent (in 



lo8 DISEASES FROM EXCESS AND MASTURBATIO!^. 

my experience) than they get credit for. They are far oftener 
effects, than causes of the insanity. 

" When they are undoubtedly the causes, the insanity resulting 
(generally Primary Dementia in the case of onanism, and Gen- 
eral Paresis in the case of sexual excess) is usually incurable 
under any known system of treatment." 

In reference to the same point, Dr. E. C. Spitzka says : 
*' Where masturbation is a pronounced feature some writers use 
the designation ' insanity of masturbation.' In reality the mas- 
turbation, although a frequent accompaniment, and perhaps a 
result of hebephrenia, is not its cause, however much this habit 
may ultimately modify the character of the psychosis. 

" The claim that there is a constant relation of sexual 
excesses to the development of paretic dementia, as pri- 
mary causes, contradicted as it has been by high authority, is 
not supported by these figures. No one will claim that the 
Anglo-Saxon is more libidinous or less able to endure indul- 
gences than the other races. If any reflection were to be cast 
on any race in this respect, it would be the negro race — which 
shows the least percentage of paretic dementia — to which a li- 
bidinous character might be assigned. AVhen it is borne in 
mind, too, that where the negro lives under conditions natural to 
him, and where he is not compelled to enter into competition 
with a higher race, paretic dementia is almost unknown.'* 

NYMPHOMANIA, 

Sometimes called furor uterinus, is a disease peculiar to fe- 
males. It often arises from masturbation, or excessive sexual 
indulgence. It has also been known to occur from the sudden 
cessation of such pleasures. Sometimes it manifests itself in 
healthy young women who have never masturbated, and who 



DISEASES FROM EXCESS AND MASTURBATION. I09 

are innocent of any practical knowledge of the sexual relations. 
Such persons are naturally passionate, and their unsatisfied de- 
sires, their continence, is the real exciting cause of the affec- 
tion. 

Nymphomania is apt to occur between the ages of sixteen 
and twenty-five. Blondes are more frequently subject to it than 
brunettes. It is characterized by an uncontrollable appetite for 
lascivious pleasures, exhibited (in its worst forms) in public and 
private, without regard to time, place, or surroundings. In m.ld 
cases the patient is nervous, easily excited, subject to hysterical 
attacks, and is constantly exciting herself in various ways to 
provoke an orgasm. The mind is full of lascivious ideas which 
find vent in self-pollution. While there is any modesty left, the 
patient -deceives every one with regard to the true state of her 
feelings. She will invent numberless diseases to account for 
her condition, and for the purpose of being manipulated by the 
surgeon. Every disease that necessitates an examination of the 
genitals will in turn be taken up. A curious instance of this 
nature occurred in my wards, while House Physician in Belle- 
vue Hospital. A girl aged eighteen was admitted, supposed to 
be suffering from retention of urine. She was thin, her eyes 
were deep-set, but bright and staring, and were often filled with 
tears. Her statement was to the effect that she had passed no 
water in three days ; that she was subject to these attacks, and 
was treated by having her water drawn off. I introduced the 
catheter and found only a few ounces of urine in her bladder, 
not enough, indeed, to corroborate her history. The next morn- 
ing, as she had not urinated during the night, I drew off the 
urine again. While doing so I noticed by a series of peculiar 
convulsive movements, that she was under the influence of strong 
excitement. A further examination showed that the labia minora. 



tlO DISEASES FROM EXCESS AND MASTURBATION. 

clitoris, and adjacent parts were red and swollen, and bathed in 
a profuse mucous secretion. I then remembered that on the 
previous evening she had shown a somewhat similar state of ex- 
citement, and gave the nurse orders to watch her closely all 
day. In the evening the nurse informed me that the patient 
kept up a constant friction of the genitals, when she supposed 
no one was watching. And even when eyes were on her, en- 
deavored, by uneasy movements in the bed, to continue the 
titillation. Knowing, then, what I had to deal with, the pa- 
tient was given a sedative, and told that she must empty her 
bladder without assistance. For thirty-six hours subsequently 
she obstinately insisted on her inability to urinate ; but when 
she was assured no catheter would be employed again, there 
was no further retention. Soon after she left the hospital I 
learned that a friend of mine, a physician, was treating her for 
uterine disorder ; but he, too, soon found out the true nature 
of the case, and advised her to get married. What afterwards 
became of her I do not know. 

Winslow gives an example of the worst form of nymphoma- 
nia, in the following case : The patient was highly educated, 
of good family, and with everything about her to make her con- 
tented and happy. Unfortunately she learned to masturbate. 
The habit took complete possession of her. At the age of 
eighteen she threw off all disguise, and masturbated, morning, 
noon and night. No circumstance prevented her. And even 
when placed in charge of attendants, and unable to employ her 
hands, she indulged in the vilest language and filthiest ges- 
tures to all who came near her. Finally she became a raving 
maniac, and was sent to an asylum, where death soon released 
her from her terrible sufferings. 

The only cure for the affection is marriage, or amputation 



DISEASES FROM EXCESS AND MASTURBATION. ill 

of the clitoris, according to the plan recommended by Baker 
Brown, who has reported numerous cures by the operation. 
In this connection it may be well to mention that Dr. Brown 
incurred the enmity of his professional brethren for a too 
free use of the operation in this as well as allied affections, 
and was, I think, compelled to leave some of the London 
medical societies, of which he was a prominent member. 

SATYRIASIS 

Is an affection of the male, corresponding, in all its essential 
features, to nymphomania. It is a rarer form of disease than 
nymphomania, because the man can gratify his venereal sense 
with impunity, while a woman is put under a ban, and com- 
pelled to suppress her passions regardless of consequences to 
her nervous system. Satyriasis is not so often found among 
young men as nymphomania is among young women. It is 
more apt to occur in advanced years. The disease may arise 
from onanism, excessive sexual intercourse, cerebral affections, 
or the administration of poisonous doses of cantharides. Oc- 
casionally, continence is a cause of the disease. The case 
of Blandet is a good illustration of abstinence from sexual con- 
gress producing satyriasis. He was a missionary, earnest and 
full of zeal. His nature was intensely passionate, but he nev- 
ertheless kept himself free from every sexual vice. Finally, 
unable to endure the sight of the opposite sex without intense 
excitement, he secluded himself far from them. But absence 
only fanned the flame until he became satyriasic to an extraor- 
dinary degree. He was only cured by indulging his passion in 
a natural manner. Acton relates the case of a man advanced 
in years who was so much affected by the disease that he mas- 
turbated whenever females were in his society. The same au- 



112 DISEASES FROM EXCESS AND MASTURBATIOM. 

thor graphically describes another case : " He was young and 
in good circumstances, but was habitually untidy about his head 
and hair. His face was flushed, the cheeks and nose especially. 
His eyes were hollow, and had a haggard expression. The lips 
were thick and sensuous, the mouth wide. He was short and 
thick-set, and of a full habit of body. I never saw a case in 
which the animal was so prominent, although his intellect had 
not been altogether neglected. I learned that early in life he 
had masturbated himself, but had left off the practice only to 
commit excesses with women, of a nature and extent that were 
shocking to hear of." 

Dr. Hammond relates the following : " This man has a wife 
and several beautiful children, and within the sanctity 
of his home, where he is always to be found during the even- 
ing, his precept and example are so noble and pure and good, 
that his influence is felt and praised by all of his many friends 
and admirers. But at stated periods, away from home, he is a 
holy terror to the biblical standard of those who have the 
promise of seeing God, an angel of mercy to the fast women 
whom he patronizes, and an insoluble enigma to all mankind. 
He has never been known to cohabit with a lewd woman, or to 
speak an immodest word ; but he is a liberal customer of cer- 
tain houses of ill repute. His custom is to go early in the 
afternoon, select two or three of the largest girls in the house, 
and repair to a private room and lock the door. Here he 
divests himself of every stitch of clothing from the waist up- 
wards, but never removes his trowsers or boots. Then, lying 
prostrate on the floor, with his arms lightly crossed over the 
abdomen and his hands tightly closed, he commands his com- 
panions to walk over his naked chest, neck and face, taking 
care to stop at each step to grind his flesh with the heels of 



DISEASES FROM EXCESS AND MASTURBATION. 11;^ 

their boots. After this process has continued for some time, 
he begins to buy the wine for the girls to drink but religiously 
abstains from taking a drop himself. 

" About the only noticeable interest he takes in the proceed- 
ings is an occasional demand for a heavier girl, or for some 
means by which they can increase the severity of the punish- 
ment. The tramping process goes on uninterruptedly for two 
or three hours, at the end of which time he will have ordered a 
dozen more bottles of wine, besides paying the fair trampers 
handsomely for their time and trouble. 

** One of his diversions is to make one of the girls stand on 
his chest with her entire weight on one boot-heel, and have the 
other girls spin her around till his flesh is torn and bleeding. 
He will also frequently direct a girl to place one foot across 
liis eyes, with the boot-heel resting in one orbit and the other 
foot resting across his throat. He will keep her in this position 
for five or ten minutes, thus sustaining a weight of one hundred 
and fifty pounds or more. It would be impossible to mention 
all the means of torture that this man has invented and sub- 
mitted to, but I merely mention these few facts as being sam- 
ples of dozens which I have heard of. At the conclusion of one of 
these matinees, our hero puts himself through a course of rub- 
bing his injured spots with his naked hands ; and a very strange 
part of the story is the fact that by this simple process his 
bruises, scars, and ecchymoses will almost entirely disappear 
within a very few minutes. Having thus rubbed himself back to a 
state of presentability, he resumes his clothing, pays his bill, 
and takes himself off to the marts of trade, but only to return 
and repeat the strange entertainment in about a week." 

"Another case, was a young man, a cigar dealer of this city, 
who from a very early period of his life had contracted the 
8 



ti4 tilSEASES FROM EXCESS AND MASTURBATION. 

habit of introducing substances into the anus for the purpose 
of having sexual pleasure. He had been led to the practice 
by seeing, while yet a very young child, a dog coupled with a 
bitch, and supposing that the connection was by the anus, he 
had inserted a wooden lead pencil into the corresponding open- 
ing of his own body. This had caused him some local pain 
but it had also produced a singular but voluptuous sensation 
the exact location of which he was not able to fix. 

" At this time he was about seven years old. In a few days 
he repeated the operation with a like result, but on this occa- 
sion with the handle of a toothbrush well oiled. Again he 
experienced pleasure which was distinctly referable to the penis. 
After this he often performed this act, using always the same 
article with which to accomplish his purpose. 

" At about the age of ten he was initiated into masturbation 
and pederasty by the boys of a boarding-school to which he 
was sent. Masturbation, however, gave him no pleasure, 
neither did pederasty when he was the active agent. Indeed 
he had difficulty in getting an erection sufficiently vigorous for 
the purpose. His weakness in this respect was soon discovered, 
and he was relieved from that part of the performance very 
much in accordance with his wishes,as the role of the passive gave 
him more pleasure than that of the active agent. Every night, 
therefore, he took part in these shameful performances and fre- 
quently to the extent of half a dozen or more times. On each 
occasion he experienced the voluptuous sensations to obtain 
which was rapidly becoming one of the chief objects of his 
life. He remained at the school five years, and then left it to 
go into a tobacco mercantile establishment to learn the busi- 
ness, but, as he said, with his health shattered, his nervous 
system irritable, with almost constant headaches, and with 



DISEASES FROM EXCESS AND MASTURBATION. II5 

such a degree of relaxation of the sphincter ani as to sometimes 
make it impossible for him to hold his feces after they had 
once reached the rectum. 

" At this time he formed an association for pederastic pur- 
poses with a young man who was to take the active while he 
himself was to take the passive part. Articles of agreement 
were drawn up between them in which each swore eternal 
fidelity to the other, and in which they were called, respectively, 
husband and wife. They took a room together and at night 
slept in the one bed. There were two beds in the room and 
both were occupied for a few minutes so as not to excite sus- 
picion, and then the one who was in this disgusting arrange- 
ment to act the part of the " husband " came to his " wife's " bed 
and remained there during the night. Generally pederasty 
was practiced night and morning. 

" Frequently the passive agent would array himself in female 
attire and would sit up at night waiting for the other to return 
home — sometimes he was kept out late by business, which was 
that of a liquor dealer — and he would receive him with every 
demonstration of affection." 

In the worse cases of satyriasis, the patient is indeed, a 
maniac. The delirium is of a violent character, and death 
may occur in a short time from convulsions or from sup- 
purative inflammation of the genitals, the result of self- 
inflicted violence. 

If the disease has a cerebral origin it is incurable. The 
other forms are sometimes amenable to treatment. Cold bath- 
ing, applications of ice to the sacrum, perineum, and genitals, 
with the internal administration of aconite, camphor, bromide 
of potassium, and other sedatives will often give relief. It is 
well also in these cases or in such cases as are of full habit, to em- 



Il6 DISEASES FROM EXCESS AND MASTURBATION. 

ploy severe antiphlogistic measures, even to a point where it 
reaches the line of danger. Nausea kept up for a few days by 
administration of a solution of antimony will be of benefit. 
And I would also recommend in addition to the antimony a 
few doses of any active cathartic, such as jalap or podophyllin, 
or elaterium. The application of the actual cautery to the 
back of the neck as high up as the occiput would be of service; 
if, as many think, the disease takes its origin in over excitation 
of the nerve fibres of the cerebellum, or some of the ganglia 
in the neighborhood, it should be one of the first things tried. 
Blisters and setons might also be used with benefit. 

ASPERMATISM. 

This affection is characterized by an absence of the orgasm 
and non-ejaculation of the seminal fluid during sexual inter- 
course. It is generally the result of masturbation commenced 
in early life, and discontinued at maturity to commence the 
more natural act of cohabitation. The inability to cohabit often 
exists, and the aspermatism comes on when the patient has had 
a surfeit of enjoyment. The power of erection remains intact, 
but the patient exerts himself in vain to produce an orgasm. 
This condition may continue for a couple of weeks, disappear, 
and then return. It is by no means a permanent condition, but 
it may lead to sterility and impotence. Some writers say that 
it is due to spasm of the orifices of the ejaculatory duct, which 
prevents the passage of the seminal fluid into the urethra ; 
others, that it is due to a lack of secretion in the various 
glands. This latter view, however, is not tenable, because 
patients with aspermatism are subject to nocturnal pollutions 
as a result of lascivious dreams. 

It is more than probable that there is a temporary paralysis 



DISEASES FROM EXCESS AND MASTURBATION. II7 

of sensation existing in the prostatic portion of the urethra, in 
the ducts, and perhaps in the vesicles. This lack of sensation 
prevents the reflex muscular action necessary for the propul- 
sion of the semen. 

Van Buren and Keyes mention cases which have no connec- 
tion whatever with either sexual excess or masturbation. I 
have seen cases, in private practice, depending solely on self 
abuse. None of the patients were impotent. They were able 
to cohabit, without difficulty, but seldom enjoyed it because of the 
absence of a natural termination to the act. One of these 
patients was a married man, who, as a lad, abused himself. He 
was capable of keeping up connection for three-quarters of an 
hour at a time without an emission. At intervals, on other 
occasions, the emissions would take place at the commence- 
ment of the act. The lack of sensation during intercourse was 
not permanent. It would continue for three or four months, 
and at the end of that time the act would be natural and pleas- 
urable. Electricity relieved this patient, but did not accom- 
plish a perfect cure. 

Acton terms this condition " non-emission," and thinks the 
principal cause is stricture of the urethra, and that the best 
treatment for it is to divide the stricture. But in the same 
chapter he has the following: "I met with a most singular case 
of this kind some time ago. The patient was an American. 
Erection was perfect, but emission did not follow. When erec- 
tion ceased there was occasionally a slight oozing from the 
urethra. Strange to say, this patient had emissions at night, 
once or twice a week. The testicles were small. A short time 
before, he had been operated on for varicocele, without any 
good effect. He had also been cauterized. Slight stricture 
existed, as was ascertained by the bulbed instrument, but a 



Il8 DISEASES FROM EXCESS AND MASTURBATION. 

conical bougie passed easily. In this instance there was appar- 
ently nothing but a want of co-ordinate action between emis- 
sion and erection, both being perfect at different times. The 
patient, under proper treatment, ultimately recovered." 

I have obtained the best results from compelling the patient 
to abstain from intercourse, making daily applications of the 
Faradic current to the genitals in the method hereinafter 
described, and giving tonics into the composition of which the 
alkaloids of nux vomica enter largely. 



Or lack of power to propagate the species, is associated with 
impotence, although there are many other factors in its pro- 
duction besides lack of virility. Indeed, inability to copulate 
does not necessarily make the patient sterile. If the seminal 
fluid be merely left at the entrance to the vagina by a prema- 
ture ejaculation, the spermatozoa may find their way to the 
uterus without much difficulty. As a proof of this, the numer- 
ous cases of impregnation occurring without intromission or 
rupture of the hymen are amply sufficient. 

Sterility may also result from inflammatory occlusion of the 
ejaculatory ducts, arising from cauterization of the prostate 
portion of the urethra. Lallemand was accused of producing 
many cases of sterility by his method of cauterizing the urethra 
for spermatorrhoea, — perhaps, however, with little reason. 

Inflammation of the epididymis will also cause it by occlud- 
ing the seminal ducts and preventing the passage of the sem- 
inal fluid through them. Destruction of the testicles will, of 
course, produce incurable sterility. 

Obesity or corpulence is mentioned by Carpenter as a factor 
in the production of sterility. " It must be observed that there 



DISEASES FROM EXCESS AND MASTURBATION. II9 

is a certain .degree of antagonism between the nutritive and 
the generative functions, the one set being exercised at the 
expense of the other. The generative apparatus derives the 
materials of its operations through the nutritive system and is 
entirely dependent upon it for the continuance of its activity. 
If, therefore, the generative activity be excessive, it will neces- 
sarily draw off some portion of the aliment destined for the 
maintenance of the fabric at large. It may be universally 
observed that where the nutritive functions are particularly 
active in supporting the individual the reproductive system is 
in a corresponding degree undeveloped, and vice versa'* 

That excessive corpulence tends to generative debility or 
sterility is brought almost daily under my notice. It is like- 
wise becoming very well known amongst breeders of the finest 
stock. At the veterinary college I have had various opportu- 
nities of seeing this exemplified. It is noticed that sterility in 
bulls rarely occurs in the commoner sorts. Those that have 
been sent to the college, in consequence of not getting stock, 
are found to be the high-bred prize animals. This class is not 
prolific, the owners caring only to breed animals that produce 
fat readily. If we had the statistics of these high-bred cattle, 
we should find that the large prices obtained for them are fully 
warranted, as the sire and dams are anything but prolific, and 
the vulgar saying, " a lean dog for a bitch," is a terse but sig- 
nificant mode of enunciating a prominent fact. 

" I was in conversation with a gentleman, a large farmer in 
Suffolk. He told me that he is often disappointed when he 
wishes to breed from cart-mares. This year, out of his own 
working stock of twenty-eight horses, eleven mares did not 
stand, greatly to his disappointment and loss, as a yearling colt 
is worth twenty pounds, and the mare ceases work only during 



I20 DISEASES FROM EXCESS AND MASTURBATION. 

one month before and one month after parturition. This sterility- 
he attributes to the high condition his cattle are kept in by the 
carters, who, proud of their teams, do not care to see them in 
foal. To obviate it fresh stallions have been purchased, and 
with as little success, sterility still prevailing. Among these 
eleven mares there were young as well as old ones, but none of 
them proved in foal. 

" The treatment of cases of corpulence has within the last few 
years excited considerable attention, no doubt through the pam- 
phlet of Mr. Banting, who, however, is indebted to Mr. Harvey, 
a member of our profession, for the plan he recommends. I have 
from the first strongly recommended the chief features of the 
system as beneficial for the general health, especially in the case 
of persons of corpulent tendency. No doubt can exist that ab- 
stinence from or extreme moderation in the use of fat, butter, 
milk, cream, bread, potatoes, sugar, and beer will in one week 
considerably diminish the weight, and in fat persons remove 
many uncomfortable sensations. When a patient is over stout the 
weight may be fairly and safely reduced one or two pounds 
weekly. I have often found such treatment assist the recovery 
of sexual power in persons in whom it has been failing. Absti- 
nence has been proved to work equally well with animals, and I 
have heard of several instances of over-fat bulls that had become 
sterile, recovering their procreative powers after being sent to 
work on the farm upon less food." 

The treatment of sterility consists in removing the cause and 
improving the general health. 



CHAPTER VII. 

DISEASES OF THE GENITALS THAT ARISE FROM MASTURBATION 

AND SEXUAL EXCESS. 

Causes of Varicocele — General changes in the Spermatic Veins — Effects of 
the Congestion and Dilatation of the Veins on the Neighboring Tissues — 
Mental Depression produced by Varicocele — Emissions and Impotence as 
a result — Ligation of Veins as a means of cure — Caustic Applications — 
Galvano-Cautery, etc. — Amputation of the Scrotum the only safe Opera- 
tion — Ecchymosis of Scrotum — Neuralgia of the Testicle — Irritable 
Testicle — Various Methods of Treatment — Neuralgia of the Neck of the 
Bladder — Treatment — Spasm of the Muscles at the Neck of the Bladder 
as a cause of Impotence — Congestion and Inflammation of the Prostate 
Gland — Treatment. 

Sir Astley Cooper once said : " Varicocele should scarcely 
receive the title of a disease, for it produces in the greater 
number of cases no pain, no inconvenience, and no diminution 
of the virile power." If that eminent surgeon lived at the 
present day and could see the cases that present themselves for 
treatment at the city dispensaries and hospitals, as well as 
those in private practice, he would be compelled to modify, if 
not change entirely the opinion quoted above. The fact is 
that while there are cases of the disease which seem to trouble 
the patient but little, the vast majority are accompanied by 
more or less general weakness, by relaxation, by nocturnal pol- 
lutions, and by great mental anxiety. Some of the old writers 
on the subject state that mental depression is the principal ac- 
companiment of the disease. This is doubtless true of most 
cases of fully developed varicocele (cirsocele\ but it is a ques- 



122 DISEASES FROM MASTURBATION AND EXCESS. 

tion whether the depression and anxiety are due to the previous 
bad habits of the patient or to the varicocele. The seminal 
weakness and the seminal losses, when they are present, suffi- 
ciently account for the mental trouble ; but these may, of 
course, be increased by the disease itself. The imagination of 
the patient is apt to exaggerate every abnormal change which 
takes place in the genital organs, no matter what importance 
may be attached to it by the surgeon. 

Varicocele generally occurs on the left side. It consists in 
a varicose dilatation of the veins in the spermatic cord, and 
exists independently of varicose enlargement in the veins of 
the extremities or other parts of the body. Persons of ad- 
vanced age frequently suffer from varicose veins of the lower 
extremities, without having any disease of the veins elsewhere. 
Young adults are particularly susceptible to varicocele, and 
rarely have any dilatation of the veins of the extremities. There 
seems to be no connection between the two diseases. 

When varicocele exists in young persons it is a positive sign 
of some derangement of the genital organs, the result of mas- 
turbation or of sexual excess, — generally the former. 

The dilatation occurs on the left side from a variety of causes. 
In the first place, the veins of the spermatic cord empty at 
right angles, on the left side, into the renal vein ; while on the 
right side the vein opens obliquely into the ascending vena 
cava, thus making it easier for the blood to ascend and gain the 
general circulation. Then, again, the pressure of impacted 
feces in the sigmoid flexure, which is apt to occur in all cases 
of constipation, will by the pressure exerted obstruct the cir- 
culation through the spermatic veins and thus assist in the pro- 
duction of varicocele, when there is any relaxation of the veins 
of the cord present. The extra length of the cord on the left 



DISEASES FROM MASTURBATION AND EXCESS. I23 

side has not, I think, much to do with the development of the 
disease. 

As the spermatic veins dilate, they become engorged with 
blood. The circulation through them is retarded, and as a 
consequence the venous radicles which supply them are con- 
gested. The weight of the increased mass of blood, together 
with the retardation of the circulation of the blood (owing to the 
stagnation in the vessels) may retard the nutritive processes in 
the testicle so as to cause atrophy of the organ after a time. The 
congestion is not confined to the testicles involved, but soon 
extends to other parts, producing a marked irritability and ex- 
cessive secretion from the glandular structure of the genitals, 
which are evidenced by the frequency of the spermatic dis- 
charges and the impaired virility. The nocturnal pollutions, if 
they do not appear before, are co-incident with the develop- 
ment of the varicose condition of the spermatic veins, and as 
the disease progresses there is more or less impairment of the 
copulative function. 

Not long since a student of the medical department of the 
University consulted me about a varicocele, which had de- 
veloped three years previously. He was a stout, hardy young 
man of twenty-two, of good habits, comparatively speaking, 
and one who had rarely been guilty of the habit of mastur- 
bating. The varicocele was, as is usually the case, on the left 
side. It was large, and seemed to envelop the testicle. The 
testicle seemed to be of normal size ; the penis showed no 
signs of misuse. He had nocturnal emissions as often as four 
times each week, and he was conscious of some impairment of 
virile power= These abnormal conditions made him exceedingly 
unhappy and despondent He slept poorly, his appetite was 
bad, study was irksome, and he had little hope of any treat- 



124 DISEASES FROM MASTURBATION ANt) EXCESS. 

ment effecting a cure, because he had for the two years pre- 
vious been taking, without benefit, every kind of quack nos- 
trum he could find as well as orthodox medicine. A few days 
after I first saw him I made a natural suspensory badge for him 
by removing the lower and relaxed pendulous portion of 
the scrotum. The operation proved very beneficial. He 
improved rapidly after it, and, with other appropriate means, 
he completely recovered his health. Eighteen months after the 
operation he was free from his frequent emissions and his men- 
tal despondency had disappeared. 

Many such cases have come under my notice during the past 
fifteen years, and in nearly all remarkable amelioration of all 
the symptoms was produced by amputation of the scrotum. 

Some authorities think that varicocele is more often a cause of 
the disease, than an effect. The general relaxation of the 
bloodvessels, and the tendency to dilatation of veins, which exist 
as a result of masturbation, is likely to be localized in the 
spermatic veins of the left side, more than anywhere else. 

There can be no doubt that the general relaxation of the 
bloodvessels with the tendency to a general dilatation of the 
veins, which exists as a result of excess and onanism, is one of 
the principal factors in the production of dilatation of the veins 
of the testicle and spermatic cord. The frequent erections and 
constant turgescence of the bloodvessels of the genitals must 
cause, finally, varicose enlargements on the side most readily 
predisposed to it. The irritability which is thus engendered 
increases the frequency of the emissions, adds to the mental 
distress, and may ultimately destroy the already impaired 
virility of the patient. 

While I believe that a large majority of cases of varicocele 
result from masturbation and excessive sexual indulgence, yet 



t)lSEASES FROM MASTURBATION AND EXCESS. 1 25 

there are cases to which no such history can be attached, and 
where all the parts are otherwise healthy. These are always 
amenable to treatment, and are cured in a much shorter time 
than the others. 

The treatment of varicocele should commence by removing 
the cause of the disease. If the patient's habits are the basic 
cause of the trouble, it will be of little use to attempt anything, 
unless these habits are abandoned. When that is done, he has 
taken the principal step towards recovery. The general health 
should first receive attention. The constipation, which is an 
invariable attendant of the disease, must be gradually removed, 
without the use of active cathartics (see treatment of sperma- 
torrhoea and impotence). Cathartic medicines in ordinary 
use are apt to disorder the stomach and be followed by the 
same lethargic condition of the bowels which existed before. 

Belladonna is a good remedy to try in all cases of constipa- 
tion, where the patient cannot stand depletion. It is highly 
recommended by Bartholow, who advises half a grain of the 
extract in pill form at bedtime. The following combination, 
which is recommended by the same authority, and which I have 
myself employed extensively with excellent results, can be used 
in all the cases under consideration : R. Ext. belladonna, ext. 
nucis vomicae, ext. physostigmatis, aa. gr. iij. M. ft. pil. no. 
vj. Sig. One pill may be given at bed time. If, as sometimes 
happens with delicate people, this pill acts too severely, half 
maybe given, or the pill may be given every other night. Some- 
times the injection of a couple of ounces of sweet oil at night 
will produce an evacuation in the morning. Injections of cold 
water will also be of service (see page 225). Another excel- 
lent combination for the cure of habitual constipation, is a 
pill made of one quarter of a grain of nux vomica and the 



126 DISEASES FROM MASTURBATION AND EXCfeSS. 

same quantity of aloin. This pill, also, is to be taken at bed 
time. 

Brisk rubbing of the abdomen, in the morning and evening, 
in addition to the general rubbing will also be of great value in 
promoting a healthy action of the bowels, and should never be 
omitted. 

Cold baths stand at the head of the list of palliative 
measures in the treatment of varicocele. General and local bath- 
ing are both beneficial. The ordinary Sitz bath is the most 
efficient bath for local effects (See page 230 for methods of 
administering the bath). 

Tonics, such as are advised in the treatment of spermator- 
rhoea and impotence at page 241, are also necessary. 

A well fitting suspensory bandage should be worn constantly, 
unless the skin becomes much chafed, during walking or other 
exercise. In such a case it may be dispensed with during the 
sleeping hours, and a wet towel substituted. The towel should 
be wet in the center and so arranged that the wet part will 
envelope both sides or the whole of the scrotum, the dry ends 
to be carried up on each side, and fastened together, to a band- 
age under the "waist. When the -yy^t towel is worn in this way, 
the inflammation of the skin produced by the bandage worn 
during the day, will be relieved, allowing it to be worn again 
without much trouble the day following. Besides taking the 
place of the elastic suspensory at night, the water bandage re- 
lieves the overloaded veins and the internal congestion pro- 
duced by them, and brings about a more healthy action in all 
the neighboring parts. 

In the majority of the cases of varicocele, the palliative 
measures should be tried before any operative procedures are 
commenced. With regard to operations many are recommendedj 



DISEASES FROM MASTURBATION AND EXCESS. 12;/ 

from which the surgeon may choose, but there is only one op- 
eration on the list that I regard as free from danger, and that 
is amputation of the pendulous portion of the scrotum, and 
making a natural suspensory bandage, which by its regular and 
even pressure, will diminish the size of the dilated blood- 
vessels and relieve the congestion permanently. All the other 
operations are attended with danger ; the patient may lose 
his life from any one of them, and, in view of the fact that the 
disease we are endeavoring to cure is never a cause of death, 
we have no right to perform an operation, attended with danger 
to life, especially when we have a comparatively simple one, 
which answers all purposes, and is perhaps more effectual than 
any of the others. 

The operation for ligation of the veins, for the radical cure 
of varicocele, is apt to be followed by atrophy of the testicles, and 
in rare instances by the formation of thrombi, which are often 
carried to distant organs, producing great and sometimes fatal 
complications. Deplech, a French surgeon, was assassinated 
by a patient upon whom he had operated for varicocele, by 
ligating the veins of both sides. Atrophy of the testicles took 
place, and the enraged patient avenged himself by murdering 
the operator (Van Buren and Keyes.) Excision of the veins 
also has been performed, sometimes with beneficial results, at 
other times it has been marked by disaster and failure. Gal- 
vano-cautery, caustics, and injections, have also been tried, 
but they are open to the same objections as the rest. 

Amputation of the scrotum, first recommended I believe by 
Sir Astley Cooper, has been performed by all the principal 
surgeons in this country many times during the past twenty 
years. It may be done with or without a clamp. It will be 
well for novices to use a clamp such as is advised by Sayre, 



128 DISEASES FROM MASTURBATION AND EXCESS. 

Levis, Henry and others. I have found the index finger and 
middle fingers of the left hand to answer very well. In using 
the clamp, care must be taken not to pinch the flaccid scrotum 
too tightly, as this sometimes retards the healing process, and 
produces sloughing, owing, I suppose, to the fact that some of 
the capillary bloodvessels in the flaps are destroyed by the 
pressure. In using the clamp, or my fingers, I usually draw 
down a fold of the pendulous scrotum so that the remaining 
portion of the scrotum is tightly placed over the testicles. It 
is better to have the covering too tight than too loose. If it is 
too tight at first, the elastic scrotum will stretch sufficiently to 
make the pressure right in the course of time. When a satis- 
factory amount of scrotal tissue has been included in the 
clamp, I pass a sufficient number of sutures through the scro- 
tal walls behind and close to the clamp, so as to close the 
wound perfectly when the redundant tissue is removed. This 
maneuver saves time, prevents the retraction of the flaps, 
gives the operator perfect command of the bleeding edges, and 
greatly facilitates all the subsequent steps of the operation. 
vVhen the threads are in place the pendulous portion is cut off 
close to the clamp with a sharp scissors or a scalpel. The clamp 
is then loosened, all the bleeding vessels secured, and the 
oozing prevented by the application of a dry towel, before the 
edges of the wound are drawn together by the sutures. If 
the bleeding is not stopped the hemorrhage may take place into 
the scrotal sac, distending it, and giving rise to a great deal of 
discomfort. To the novice, this effect is alarming. The scro- 
tum is enormously distended and of a bluish black color, look- 
ing as if the whole mass were in a state of gangrene. Under 
such circumstances, the proper thing to do is to cut all the 
sutures, turn out all the clots, and tie or twist all the bleeding 



Diseases from masturbation and excess. 129 

vessels. Cloths dipped in ice water must then be kept on to 
prevent any capillary oozing or subsequent inflammatory action. 

When the operation is concluded the scrotum should be 
covered with cloths wet with a cold carbolized solution, and 
these cloths should be kept constantly wet for the first week. 
Daily washing of the wounded surface is also necessary until 
there is perfect union. 

When the patient is able to go about, which is usually at the 
end of two or three weeks, a suspensory bandage is necessary, 
and should be worn for several weeks, just as if no operation 
had been performed. This prevents any accidental stretching 
of the flaps, and controls the congestion until all the tissues 
are firm, and fixed, and the veins reduced to their normal size. 

In many cases a period of ten or twelve years may pass 
before there is any appearance of a relapse, in others, how- 
ever, the disease may begin again within five or six years. In 
these cases it will be generally found that the operation has 
been performed imperfectly, or that the patients have renewed 
habits, formerly discontinued, which have been destroying their 
health. Patients who, after the operation, remain temperate 
and enter the married state, rarely if ever have a return of the 
disease. Even late in life, in such cases, the veins as well as 
the scrotum are in a healthy condition. 

NEURALGIA OF THE TESTICLES. 

This distressing affection is frequently caused by onanism 
and sexual excess, and it is often accompanied by a loss of 
virility. It may also arise from malaria, rheumatism, strictures 
of the urethra, prostatic enlargement, and varicocele. In some 
instances it is a legacy of acute or chronic orchitis. The dis- 
ease is rare among married men and others who are able to 
9 



130 DISEASES FROM MASTURBATION AND EXCESS. 

fulfill their sexual functions in a temperate or reasonable man- 
ner. This fact shows the intimate relation which exists between 
neuralgia of the testicles and bad " sexual hygiene," and that 
the latter requires special consideration before the other excit- 
ing and predisposing causes. 

The testicle in these cases is invariably tender on pressure 
while the attack is on. All muscular movements of the lower 
parts of the body, walking or climbing, or any exercise which 
allows contact or pressure of the limbs on the diseased organ 
will increase the pain. The pain is generally spasmodic in 
character, either sharp or stinging, or a dull ache. The dura- 
tion of the attack varies as in other forms of neuralgia, some- 
times lasting but a few moments, then again continuing for 
hours with a greater or less degree of severity. During the 
attack the patient is weak and pallid, perspires profusely, and 
sometimes vomits. The slightest touch increases the paroxysm. 
In bad cases the patient's life soon becomes a burden to him, 
and he will often endeavor to persuade the surgeon to remove 
the organ without delay, and before any other method of treat- 
ment has been employed. 

If the testicle is swollen the emissions are generally frequent. 
Though the patient may be full of erotic fancies, he rarely 
attempts sexual congress because of the aggravation of the 
pain usually caused by such attempts. Curling mentions the 
case of a man, a patient of his, who was unable to cohabit with 
his wife owing to the excessive pain which came on at the 
time, and was often so great as to cause fainting. 

IRRITABLE TESTICLE 

Is nothing but a mild form of neuralgia of the testicle. It is 
seldom accompanied by severe paroxysms. It may affect both 



DISEASES FROM MASTURBATION AND EXCESS. I3I 

testicles, and is more apt to affect the testicles of both sides at 
the same time than one alone. If the testicle is carefully ex- 
amined, one or more sore spots will be found exquisitely ten- 
der on pressure. The tenderness is present to a greater or less 
extent during the continuance of the disease, though with it 
also there are paroxysms of pain, especially after much excite- 
ment of the genitals, from masturbating or intercourse. The 
affection like the preceding one is generally due to bad sexual 
hygiene, or to excess of one kind or another. " Temporary 
irritable testis may be produced in a healthy person, at any 
time, by prolonged sexual excitement, ungratified. Masturba- 
tors, who have suddenly reformed, and recent widowers, and 
those who have abused their' sexual power by over use, are 
liable to the affection." (Van Buren and Keyes.) 

In some instances the disease follows injury and inflamma- 
tion in anaemic persons. 

Romberg relates the case of a young man who developed 
an irritable testicle shortly after being engaged to be married, 
the result of ungratified sexual excitement. He prevailed upon 
the doctor to remove the diseased testicle. He was relieved for 
eight days, when the disease attacked the remaining testicle. 
He concluded to get married, rather than repeat the operation. 
The marriage cured him completely. 

The general treatment directed in the beginning of the chap- 
ter to regulate the various secretions and build up the tissue 
making powers of the patient are all indicated here. When 
this has been done, and the habits of the patient are mended, 
local treatment will be found necessary. Indeed it may be 
commenced first; for the relief of the pain and soreness, either 
very cold or very hot applications are beneficial. I have found 
that the cold applications accomplished more than the hot, 



132 DISEASES FROM MASTURBATION AND EXCESS. 

though both are serviceable. A bladder filled with ice can be 
applied over the painful testicle, and retained there until relief 
is experienced. If the patient is very sensitive to the cold, a 
towel may be placed between the integument and the ice bag, 
or cloths dipped in ice water may be used instead of the ice. 
One of the best things, however, that I have found for neural- 
gia of the testicle is the cold sitz bath. It should be taken 
every night, whether the neuralgia is present or not, and also 
during the time the paroxysm of pain is present. The patient 
may remain in the bath from five to fifteen minutes, the length 
of time depending of course on the feelings of the patient, and 
his general condition. One case of severe neuralgia of the 
testicle in an impotent middle aged man, was entirely cured by 
these baths alone. He experienced so much relief from the 
first bath that he would take no other treatment, and his re- 
covery was complete as well as rapid. 

During the day a well fitting suspensory bandage should be 
worn, and the pantaloons should be as loose as possible, so as 
not to interfere with the circulation through the vessels of the 
spermatic cord on either side. I am convinced that much 
harm is often done by the absurd practice of tightening the 
garment on the " dress " side. The practice not only obstructs 
the circulation sufficiently to aggravate all diseases of the geni- 
tals, but I think it is a prominent factor in the causation of 
varicocele and the various forms of neuralgia incident to a 
rapid life about town. 

Puncturing the integument over the spermatic cord with 
needles is sometimes beneficial. It may be advisable, in very 
bad cases, to rub into the punctures a mixture of equal parts 
of croton oil and Olive oil. This application must be made 
over the upper part of the scrotum, and over a surface corres- 



DISEASES FROM MASTURBATION AND EXCESS. I33 

ponding to the width of the cord. It should not be continued 
down over the testicle. 

The Faradic current will also be found of use in many- 
cases. The positive pole may be applied over the genito- 
spinal center, at the junction of the last lumbar with the dorsal 
vertebra, and the negative electrode is then to be passed slowly 
upwards and downwards over the scrotum on the affected side. 
I have had no experience with the continuous current in the 
treatment of these cases, but by many authorities it is said to 
exercise a curative effect. 

The application of local anodynes and sedatives will be of 
some service as palliatives. Among the best combinations are 
the ordinary lead and opium wash (Lotio Plumbi et Opii) the 
ointment of opium and belladonna, /^//^yf^, belladonna plaster, 
and the ordinary porous plaster. I have found the following 
mixture to be among the best : 

5. Tinct. Aconiti . , . . 3i» 

Tinct. Belladonnas . . . • 3 ii. 

Acidi Carbolici . . , . 3i. 

Spt. Vini Rectif. . . • . | iii. 

Wet a cloth with the lotion, and keep constantly moist 
during the paroxysm. 

Another mixture of the same nature, such as the following is 
good : 

5. 01. Olivae . . . . .iii. 

Liq. Potassge , . . . 3 ss. 

Tinct. Opii . • . . 3 ii« 

Tinct. Aconiti Rad. . . . 3 ss. 

M. Shake well. 

It is to be rubbed in gently over the scrotum of the inflamed 
side, two or three times each day. 



134 DISEASES FROM MASTURBATION AND EXCESS. 

Quinine in doses of from five to fifteen grains daily is often 
of benefit, especially if the patient is the subject of any ma- 
larial tendency. In tonic doses it is good at all times. When 
the baths, or the ice, or the anodynes fail to relieve the pain, 
opium or chloral or the bromides must be resorted to. Mor- 
phia may be given hypodermically or by the mouth. Some 
advise it to be given endermically, after the skin has been 
blistered. There is no special objection to this method of ad- 
ministering the morphia. 

Castration has been recommended by some for inveterate 
cases, but every other means should have a prolonged trial 
first. Extreme measures should never be thought of until 
everything else has failed. 

It is always well to advise marriage when the patient is 
young and suffering from bad sexual hygiene. This recom- 
mendation must, of course, be governed by the condition of 
the general health. He mi st be toned up to a certain point be- 
fore the marriage can be consummated. (See page 241.) If the 
patient is full blooded, and his neuralgia is simply the result of 
unsatisfied longings, then no time need be wasted in pre- 
paratory treatment. He can be married without delay. 

NEURALGIA OF THE NECK OF THE BLADDER 

Is another affection which very often arises from onanism and 
excessive venery. It is sometimes also caused by prolonged 
continence. It occurs also as a result of gout, rheumatism, 
malaria, and as a sequel to inflammatory conditions of the 
prostate gland, bladder, and urethra, and from stricture. Even 
when these disorders are accompanied by irritability of the 
neck of the bladder, there is probably some bad sexual hygiene 
at the bottom of it 



DISEASES FROM MASTURBATION AND EXCESS. I35 

The constant distension of the prostatic ducts and the semi- 
nal ducts and the congestion which invariably attends the orgasm, 
soon produce a chronic congestion in the prostatic urethra, 
which in nervous subjects, or in persons with a neuralgic ten- 
dency produces irritability of the neck of the bladder and 
intense pain. The affection known as irritability of the neck, 
is like irritability of the testicle, only a modified form of the 
neuralgia, and by most authorities the terms are synonymous. 
Whatever may be the cause, the symptoms are characteristic. 
The patient is frequently seized with a desire to pass water. 
The evacuation of the bladder is attended with pain of more or 
less degree of severity. The pain is felt with greatest inten- 
sity at the neck, but it also extends to the thighs, and radiates 
over the perineum to the anus, around which part all the 
muscles seem to be in a state of painful contraction or cramp. 
The pain on micturition is much aggravated, if the urine con- 
tains an excess of oxalate of lime, or uric acid. The minute 
cryitals irritate the nerve filaments and increase the pain. 
There are cases recorded where the presence of these ingredi- 
ents in excessive quantity produced the neuralgia or irritabil- 
ity, and when they were removed by appropriate treatment 
the pain also disappeared. 

In neuralgia the frequent calls to urinate occur more often 
during the day than during the night. In inflammation the calls 
to urinate occur at night as well as by day. This is an import- 
ant point in diagnosis, though the examination of the urine 
alone will determine the point. The urine of cystitis always 
contains pus and triple phosphates, in excess. In simple neu- 
ralgia these elements are never present in any appreciable quan- 
tity. 

With the neuralgia, there is more or less hypochondriasiso 



136 DISEASES FROM MASTURBATION AND EXCESS. 

Mental depression, deep but not lasting, accompanies all the at- 
tacks. This arises, undoubtedly, as much from the previous ex- 
cess as it does from the pain, and is only part of the general 
weakness which follows all sexual excesses of every kind and 
nature. 

Impotence and spermatorrhoea are often present and should 
be considered in all cases. 

The passage of the sound into the bladder in one of these 
cases is attended with some difficulty on account of the extreme 
sensibility existing along the whole urethra, but especially at 
the prostatic part of the urethra. The spasmodic contraction 
of the muscular fibres around the instrument is often so great 
as to prevent, for a few moments, the entrance of the sound, 
and to give the impression that a stricture of an organic nature 
exists. If the sound is allowed to remain awhile, the spasmodic 
contraction passes away and with it all the pain, and when the 
sound is withdrawn great relief is generally experienced by the 
patient. If the pain arose from inflammation it would be in- 
tensified by the pressure of the instrument. 

The first object to be attained in the treatment of irritability 
or neuralgia of the neck of the bladder, is to diminish as much 
as possible the local causes of irritation. If the urine contains 
an excess of acids, alkalies should be given-r-if it is too alka- 
line, acids are indicated. A selection should be made from the 
various tonics advised in Chapter XIV, and careful and well 
regulated measures should be taken to keep all the sewerage of 
the body clear and in perfect working order, so that there shall 
be no undue accumulation of excrementitious material at any 
one point, or in any one organ. With the cathartic medicines 
and the baths spoken of previously this end can be attained. 

The dailv passage of a full sized steel sound is advanta- 



DISEASES FROM MASTURBATION AND EXCESS. 137 

geous in almost every case, and should never be omitted except in 
those rare cases where the neuralgia depends on well developed 
inflammation. In such cases, of course, much harm might re- 
sult from the passage of the instrument. If the sound causes 
pain and fainting, two or three days may be allowed to elapse 
before it is again introduced. 

Cold sitz baths should never be dispensed with unless there 
is some special contra-indication for their use. During the par- 
oxysm a hot sitz bath will sometimes answer better than the 
cold, but for general treatment the cold bath should be used. 
When insomnia is present, in connection with great depression, 
suppositories are beneficial ; both in relieving the irritability and 
promoting sleep, the following are excellent : 

Ex.^ Belladonnas gr. ii. 

Pulv. Opii gr* iv. 

Quinige Sulph. gr. xx. 

M. 

Make four suppositories, one to be passed into the rectum at 
bedtime. 

Electricity is another agent of great value in neuralgia of the 
neck. The negative electrode to be introduced down to the 
neck of the bladder, and the positive to be applied over the 
sacrum and perineum. The seance should not last over five 
minutes at first. In the course of a week or two it may be ex- 
tended to ten minutes. The Faradic current helps to diminish 
the pain, and it also diminishes the number of seminal emis- 
sions, an important point to remember in all these cases ; for 
while the ejaculations are in excess, the mental condition of the 
patient will be much disturbed. 

Good food, and exercise out of doors, should, of course, be 
advised in every case, as well as total abstinence from spiritu- 



138 DISEASES FROM MASTURBATION AND EXCESS. 

ous liquors and tobacco. By careful attention to all these 
points the disease can always be cured. Opium, chloral, and 
remedies of a like nature, should be given, as in other forms 
of neuralgia, when milder measures for relieving pain fail. 

I SPASM OF MUSCLES CONNECTED WITH ERECTION. 

During the act of micturition, and the ejacula ion of seminal 
fluid, there often occurs spasmodic contraction of the com- 
pressor urethra and accelator urinae, which is very perceptible 
to the patient, and is often a cause of much annoyance, espec- 
ially when, as it often does, it interferes with intercourse. The 
following case illustrates the class of cases to which I refer, and 
which has not as yet received any notice in any volume that I 
am acquainted with. « 

A. v., a native of Canada, by occupation a carpenter, applied 
for treatment at a clinic in the medical department of the Uni- 
versity of New York, where I was then lecturing. He said that 
he had been married three months, and had considerable trouble 
in effecting sexual intercourse. He had perfect erections, but 
in the midst of the act a severe throbbing of the muscles of the 
perineum would occur, and cause the erection to cease ; and 
this would occur often before an ejaculation of semen occurred. 
At times the spasmodic contraction would bring about prema- 
ture orgasm, and expulsion of semen, which prevented all 
further efforts in that direction. This rendered him, for the 
time being, impotent, and distressed him in every way. He ac- 
knowledged that in early life he had masturbated considerably, 
and had also cohabited with women. Before his marriage the 
difficulty complained of only occurred at rare intervals ; now it 
was almost a constant attendant of the attempt. Sometimes he 
was able to diminish the effect of the spasm by pressing with 



DlSEASfeS FROM MASTURBATION AND EXCESS. I39 

the fingers of the one hand firmly on the center of the peri- 
neum, maintaining the pressure until the occurrence of the or- 
gasm. I passed a full-sized sound and found great tender- 
ness all along the canal, but especially at the prostatic portion 
of the bladder. As the sound entered this portion of the canal 
the spasm again occurred, and the patient said he felt like hav- 
ing an emission or emptying his bladder. I advised sitz baths 
and the Faradic current, and abstinence from all sexual pleas- 
ures, and in a few weeks the act was unattended by the spas- 
modic contraction. 

I have seen several others who have endured great incon- 
venience from this form of spasm, but it was entirely uncon- 
nected with painful symptoms of any kind. Electricity is the 
best thing for it, but most cases require the full course of 
treatment for spermatorrhoea and impotence, recommended in 
another portion of this volume. 

CONGESTION AND INFLAMMATION OF THE PROSTATE. 

The tumefaction in the prostatic region of the urethra, pre- 
viously spoken of as a result of onanism and excessive venery, 
if continued when it exists for any great length of time, may 
sooner or later involve the whole prostate gland. The blood- 
vessels all through the gland become engorged, the prostatic 
secretion is for the time being increased, and the organ is 
larger, more tense and more tender than in health. As a con- 
sequence there is a feeling of uneasiness at the neck of the 
bladder and more frequent calls to urinate, and there is also 
an escape at frequent intervals, after the last drops of water 
have passed, of a small quantity of prostatic fluid. This secre- 
tion is sometimes clear, but in many of the cases the secretion 
is opaque from the admixture of epithelial cells and pus, and 



140 DISEASES r?.:M :.:a57 V?.Z All 2 N AND EXCESS. 

in rare insrsnces :v semen. The patier.: experiences an 
tmpleasaiit sense :: cisrensicn in :'. e ;t:l em. ;ni around the 






arge will con: 



/^Ar tTr 



sT/niaii 



sniierin^ :::::. ;: a^ts: t ::A:^_.e. rne resni: of malaria and 
ccnhnence — mire c: :he ii::e: :hin rne firmer. He did the 
" : k c: a krge pirisn, ini sizerei : : msirniiir from chills 
;.ni :e"er. .-.nd a: '.'3.:::ns Ln:cr»'a.j.5 ne nan SA/ne distress in 
a: A A^ AAer. Tde a:: of urination vtea af: lAed with 
powerful ere:rl:ns. painrnl in the extreme aa' a ned 
l:ng a::er tde bladder vra,s emnried. Ke enpeArnied no 
relief fr:n: emprdAg :de zlaider, Tde palalal .reAAAs and 

malarial arrack, but they also cccnrrei at varlAas inrer^als 
when the malaria ~ a s ad s e n r . Tde : e a . . : : d. . e a e : k of the 



blac 


Ider and 


the ;a r 


--- 


- e r e : a : A 5 _ e : :. a: e s : 




: that he 


was 


forced 


to c:m 




A :Ae cAv ::r aa'die 


ana ar "■ 


e up his 


active parish vrork. 


I 


nii^ht here remark rr 


:a: ne Zt. 


a.ra dav- 


mz 


anv ces: 


.re r : ; : 


a a 


AAr :r anv erana fee 


.mas cr 


a similar 


naA. 


— •- 


ere was 


n: 


e'a aea :e i : an'.' aai 


a :: sdA 


the 


na a 


r-.A: ::-. 


:>ed hi or 


se: 


d m aay ~ay. V/neA 


I raama 


.= _ Aim, 


I :: 


ana aa 


rlAzTlA 


-t- 


sensitive prostatic a 


:re:nra.. s 


:me ten- 


cerr 


ress in :1 


".e a ermf 


aar 


n. Tde aassaae af tl 


:e sound 


was f ol- 


. - -;-,- - 


^ a I '•" a 


"A A. a A 




-ae ErirTAAZ aaa an 


erection 


. There 


da a 


zren a: 




A 1 


aarae : e: : :- :; aa aa 


: --ledge 


except a 


■Aea 


r :Ae. :: 


ransa are 


irt 


ann SAiny. He vr3.s 


very de: 


jpondenf 



Diseases from masturbation and excess. 141 

about his condition, and thought it would be impossible for 
him ever to perform his regular duties again. He was put to 
bed, his bowels were freely moved and hot poultices were 
placed over the perineum, and he was also ordered hot sitz 
baths by the house surgeon. These measures, to a great 
extent, relieved the unpleasant sensations in making water, but 
his erections still continued with great force and frequency, 
and they were the most annoying part of his disease. He 
was then ordered large doses of bromide of potassium, and 
allowed to get up. The hot baths were exchanged for cold 
ones, and in a short time the erections ceased to be of more 
than ordinary annoyance. 

This congestion of the prostate may terminate in acute 
inflammation under increased excitement, or it may run a slow 
course and terminate in hypertrophy of the gland. A sound 
introduced into the canal will occasion great pain and a desire 
to urinate. After the urination the distress still remains to a 
greater or less degree. The introduction of the finger into the 
rectum will show that the gland is more sensitive to pressure 
than it ought to be, and that firm pressure will give pain and at 
the next urination will produce the expulsion of the prostatic 
secretion in considerable quantities. 

As before stated, if the congestion of the prostate continues 
for any great length of time a condition of acute inflammation 
may arise. This occurs sometimes in the course of an ordi- 
nary congestion by one night's dissipation with women. The 
patient may have some chilly sensations preceding the attack, 
but these are often absent. There is, with or without the 
chilly sensations, deep-seated pain in the perineum extending 
towards the anus ; pain on pressure over the pubis and per- 
ineum, and frequent desire to micturate. Every cime th.e act 



t42 Diseases from masturbation and excess. 

is performed there is sharp pain that lasts after the bladder is 
empty. The aggravation of the pain is due to the fact that 
muscular fibres of the prostate are thrown into strong contrac- 
tion in expelling the water during micturition, and the pressure 
and pulling of these muscular fibres on the inflamed tissue 
must necessarily give rise to a great deal of pain. The gland 
becomes very much enlarged, and can be felt to bulge into the 
rectum. The pressure of the finger in that organ occasions 
great pain, and with the finger the dimensions of the organ can 
readily be ascertained. The introduction of the finger will de- 
termine at once the character of the disease, so that it need 
not be confounded with cystitis, the only disease it is liable to 
be mistaken for. There is no tenderness in the rectum over the 
prostate in cystitis. In prostatitis, as also in cystitis, there is 
frequent desire to micturate and pain during the act, but in 
cystitis there is always much more pus and mucus in the 
urine than there is in prostatitis. Besides this, in cysti- 
tis there is always a larger quantity of the triple phosphates. 
Phosphates are never absent in decomposing urine in or out of 
the bladder, but are not present in prostatitis. 

The swelling of the inflamed prostate may be so great as to 
produce retention. This is more apt to occur when the disease 
arises from an extension of gonorrhoeal inflammation or from 
traumatism. Retention is a very rare occurrence in ordinary 
prostatitis. With the local symptoms the patient has also 
more or less febrile excitement. The bowels are apt to be 
constipated, the stomach is disordered and the skin is dry and 
hot. The patient is distressed in mind and exceedingly de- 
spondent. He frets, he worries about his condition more than 
the severity of the affection would warrant, and this is specially 
so in those cases which are entirely due to sexual excess or 



Diseases from masturbation and excess. 143 

onanism. Prostatitis, whether follicular or parenchymatous 
(and I think one rarely occurs without the other), will gener- 
ally terminate favorably under proper treatment. It rarely 
ends in suppuration. The worst result to be apprehended is a 
permanent enlargement or hypertrophy of the gland. The 
inflammation usually lasts from one to three weeks. The dura- 
tion, of course, depending on the cause of the disease and the 
general condition of the patient. 

The best way to deplete the vessels of the prostate gland is 
to apply four or five leeches to the margin of the anus. The 
branches of the hemorrhoidal plexus are in direct communi- 
cation with the dense prostatic plexus, and the result of the 
abstraction of blood there is to diminish in a marked degree 
the amount of blood in the gland mentioned. Unless the 
patient is exceedingly sensitive and nervous they should be 
applied without delay. After the leeches have done their work 
a saline cathartic in small but often repeated doses should be 
given. A mixture containing half an ounce of Epsom salts 
and half an ounce of bi-tartrate of potash, to half a pint of 
water, can be given in wineglassful doses, every two hours, 
until free evacuations are produced. Of course, in anaemic 
persons the cathartic and the leeches may be omitted. Hot 
linseed meal poultices applied over the perineum and hypo- 
gastric region, and changed every two or three hours, will 
afford great relief to the patient. 

Diluents should be given freely. An infusion of the triticum 
repens, hops, linseed or barley, will answer all purposes and 
keep the urine in an unirritating state. The triticum repens, 
or common couch grass, was first recommended by Sir Henry 
Thompson for cystitis and prostatitis, and it is undoubtedly of 
great use and value in all painful inflammatory affections of the 



144 DISEASES FROM MASTURBATION AND EXCESS. 

genital organs. Dr. Thompson gives its preparation as fol- 
lows : " Take two ounces of the underground stem, add it to 
one pint of water and boil for one quarter of an hour, the 
strained liquor to be taken by the patient in four doses in the 
twenty-four hours. An infusion of alchimella arve?ists may 
be given in the same way in doses of from an ounce to an 
ounce and a half every three or four hours. Liquor potassae 
and hyoscyamus in combination, though incompatible, often 
afford great relief to the pain in cystitis. Chloral in ten or 
fifteen grain doses at bed time will be of service in some cases 
in relieving pain and producing sleep." 

Hot sitz baths are also employed with benefit in these cases. 
They may be used twice each day, unless they seem to debili- 
tate the patient or disagree with him in some other way. 



CHAPTER VIII. 

DISEASES OF THE GENITALS ASSOCIATED WITH SPERMATOR- 
RHCEA AND IMPOTENCE. 

Accumulation of Secretions under a tight Prepuce as a Cause of Sperma- 
torrhoea and Impotence — Illustrative Cases — Reflex Irritation Produced 
by Phimosis— Loss of Voice from Phimosis cured by Operation — Sayre's 
unique Case — General Treatment — Congestion of the Prostate and In- 
flammation of the Prostate — Cases of Spermatorrhoea and Impotence Pro- 
duced by Them — Impotence following the Removal of Calculi from the 
Bladder by the lateral Operation — Spermatorrhoea produced by Hypo- 
spadias and Epispadias — Curvature of Penis — Large Penis — Prostatic Cal- 
culi as a cause of Spermatorrhoea. 

PHIMOSIS.^ 

When the prepuce is elongated and contracted in front of 
the glans-penis, the secretion of the sebaceous follicles ac- 
cumulates on the glans and behind the corona. At first the 
secretion is thin and cheesy in character, but after a time the 
accumulation becomes dry and hard, forming a concrete mass on 
the sensitive mucous covering of the glans. This mucous mem- 
brane is perhaps the most sensitive in the human body ; it is 
certainly the most sensitive portion of the mucous lining 
of the genitals. Hence any irritation of this membrane is 
liable to be followed by many varied reflex phenomena, which 
often baffle the skill of the most experienced. In children this 
collection of sebaceous matter will produce incontinence of 
urine, a tendency to handle the parts and to masturbate, and it 
will sometimes cause paralysis. In adults the reflex irritation 

10 



146 SPERMATORRHCEA AND IMPOTENCE. 

is excited in the seminal vesicles and ejaculatory apparatus, 
and produces numerous losses of seminal fluid. If the con- 
cretion around the glans has existed long enough to produce 
inflammation of the mucous covering, the pain will prevent in- 
tercourse and thus render the patient temporarily impotent. 

But the effects of these accumulations of sebaceous matter 
resulting from phimosis are not entirely local. The most dis- 
tant organs are likewise affected by the reflex irritation. Dr. 
Durant of this city sent me a patient twelve months since, 
who afforded an excellent illustration of the fact just stated. 
The patient was a young clergyman of good habits and tem- 
perate in all things. For several years he had been subject to 
a troublesome affection of the throat which interfered with his 
ministerial duties. Some minutes elapsed on entering the pul- 
pit before he could make his voice heard in distant parts of the 
church. He had been treated for pharyngitis, laryngitis, etc., 
without relief. Local applications as well as constitutional 
remedies failed. For several years he suffered severe pain 
while cohabiting with his wife. He commenced the act with 
regret and ended it in agony. The pain was always referred to 
the head of the penis. Latterly he had ceased intercourse or 
account of the pain, and he was consequently troubled with 
seminal emissions three or four times each week. On examin- 
ing the penis I found the prepuce contracted tightly in 
front of the glans. It was exceedingly painful on pressure and 
it was impossible to push it back. 

The next day the patient was placed under the influence of an 
anaesthetic. I removed the prepuce and exposed the glans. 
The whole surface of the mucous membrane from the corona 
glandis to within a quarter of an inch from the meatus, was 
covered by a hard thick coating of a mortar-like material. 



SPERMATORRHOEA AND IMPOTENCE. I47 

which was removed with great difficulty. In some places near 
the corona it produced ulceration by its pressure. After the 
removal of this concrete substance the operation was concluded 
in the usual way. The ulcers were dressed with lint steeped in 
olive oil. This was the only dressing employed during the 
whole course of treatment. In ten days the ulcers as well as 
the wound had completely healed. 

When the patient again entered the pulpit he found, much 
to his surprise, that the aphonia as well as other disagreeable 
laryngeal symptoms had disappeared, and that he had full 
command over his voice. Though more than a year has 
elapsed since the operation his voice has remained perfectly 
clear, and there has been no return of the affection. There 
was also complete relief from pain and other unpleasant sensa- 
tions during sexual intercourse. 

Dr. Sayre relates the following interesting case occurring in a 
boy 3^ years old : " Has frequently through the day what the 
mother terms * spasms of ecstasy,' in which he laughs immod- 
erately, and his eyes are bright and glistening, but yet he ap- 
parently sees no object, and the penis is in a state of extreme 
erection. Cannot see, although eyes have been examined 
and found sound. Unable to stand ; incapable of voluntar- 
ily contracting any of his muscles when standing, or rather 
when being held in the upright posture, as it was impossible for 
him to stand, but when lying on his back for some time can 
move his hands and turn over ; but when held upright his legs 
always spasmodically cross each other, hands close, wrists flex, 
elbows the same, in fact, all the adductor and flexor muscles 
act and produce a strange distortion ; the mouth opens, and 
there is a vacant stare of idiocy with a curious laugh of half 
intelligence. The penis is in a state of almost constant erec- 



148 SPERMATORRHCEA AND IMPOTENCE. 

tion, and greatly excited at the least irritation. The meatus 
is red and tender. Teeth nearly all destroyed by medicine, and 
is now nourished on a bottle." Phimosis, firmly adherent pre- 
puce. Dr. Sayre circumcised him on the spot, and at the next 
visit the child shook hands with him, which he had never done 
before in his life. Considerable improvement is said to have 
followed, but not a cure, as about eight months afterwards " it 
could not hold its head up with the strength of the normal 
child, although it could sit down and get up and stand, balanc- 
ing itself without assistance ; could speak several words, and 
had acquired the power of eating." 

Lallemand relates several interesting cases of spermatorrhoea 
which were caused by phimosis and accumulation of seba- 
ceous matter under the prepuce. They are exceedingly inter- 
esting : 

" A peasant consulted me for his son aged fifteen, who for 
two years had experienced a constantly increasing paralysis of 
the lower extremities. On his sides and loins were marks of 
numerous ulcers which had been tried during two years. Large 
excoriations had formed on the sacrum and trochanters. On 
examining the genital organs, I noticed that the prepuce was 
very narrow ; and on pressing it to get rid of the sebaceous 
matter which presented at its orifice, the penis became erect. 
I learned from the parents thai this boy "had erections at the age 
of eight, and that at nine years of age, he had been found attempt- 
ing coitus. The boy himself admitted that the itching with which 
he was tormented led him to rub the genital organs, and thus 
induced maneuvers which he has since continued. 

" The first symptom that presented itself was frequent desire 
of micturition, and this was followed in about a year by com- 
plete incontinence of urine. In the course of the second vear. 



SPERMATORRHCEA AND IMPOTENCE. 149 

the patient's legs grew weak ; he lost his intellectual capacity, 
digestion became disordered, diarrhoea came on ; and the dis- 
charge of urine and feces caused excoriation of the skin. 
Salt and aromatic baths, tonics, excitants, etc., had been just 
as useless as issues. The cause of the disease was unsuspected. 
Masturbation had become very rare, but the urine was thick, 
muddy, and very fetid — so much mucus was passed, that I was 
unable to make sure of its containing semen — but the patient 
had constant pollutions at stool. I first performed ablation of 
the prepuce, and eight days after, I cauterized the bladder and 
surface of the prostate. A month afterwards, the urine was 
perfectly transparent, and presented a healthy appearance ; it 
was no longer passed involuntarily. Sensibility of the skin of 
the lower extremities had returned. Improvement was here 
arrested, however, and I lost sight of the patient." 

"Another case, at twenty-three, of nervous temperament, hav- 
ing enjoyed good health up to the period of puberty, from that 
time presented a yellow and leaden appearance, with sunken 
eyes, forehead covered with acne punctata, and timid manners. 
For a long time he had appeared as if plunged into deep mel- 
ancholy, and constantly sought solitude. He was restless, but 
was unable to bear fatigue. Digestion was difficult, and his in- 
tellect dull. This disorder had lasted four or five years, but 

had increased sensibly during the last year before M. B 

came to consult me. I suspected him of bad habits, but he as- 
sured me that he had escaped them from want of desire, and 
that he had never had sexual intercourse. From the period of 
puberty, however, he had been subject to nocturnal pollutions, 
the frequency and abundance of which had progressively in- 
creased, and in spite of the means generally recommended 
in such cases, pollutions occurred every night, and sometimes 



150 SPERMATORRHCEA AND IMPOTENCE. 

two or three times during the night. He had never noticed 
ascarides in his feces, nor experienced itching at the anus. I 
was uncertain to what cause to attribute these pollutions, when, 
on examining the genital organs, I noticed that the opening of 
the prepuce was very narrow, and that abundance of sebaceous 
matter escaped. Pressure made from behind forwards pro- 
duced the discharge of a large quantity of matter of a milky 
appearance and considerable fetor. I concluded, therefore, 
that the natural phimosis, by preventing the discharge of the 
sebaceous secretion, was the cause of involuntary discharges, 
and in consequence recommended circumcision, which was 
performed immmediately. I found a large quantity of seba- 
ceous matter resembling soft cheese in color and consistence, 
and of a very disagreeable smell, covering the surface of the 
glans, and especially collected around the corona glandis. 

" The glans itself was vividly red, almost entirely deprived of 
its epithelium, extremely sensitive — the least friction causing a 
discharge of blood. 

" From this moment he passed a fortnight at a time, and some- 
times longer without having nocturnal pollutions, which after- 
wards only arose from spermatic plethora. A rapid change 
took place in health and habits, so that at the end of a month 
he was scarcely recognizable." 

"M. J.B., of Amsterdam, of delicate constitution and lympha- 
tic temperament was subject during childhood to incontinence 
of urine, and always suffered from frequent desire to make 
water. About the age of ten, a whitish matter formed, and was 
discharged from underneath the prepuce, after which erections 
occurred, and were soon followed by emissions : a very dis- 
agreeable smell accompanied the preputial discharge. The 
seminal discharges increased as the patient's passions were 



SPERMATORRHOEA AND IMPOTENCE. 151 

roused, and he grew sad, silent, discontented, and constantly 
occupied with the origin of his disorder. He imagined that the 
whitish discharges arose from venereal disease, although he had 
never had connection. His health became much disordered, 
and at the age of nineteen he mentioned his condition to his 
medical attendant. Lotions were prescribed, which removed 
the sebaceous matter and produced considerable improvement 
in the patient's health. M. B.'s bowels became constipated, 
however, and he perceived that he passed semen while at stool, 
in consequence of the effort necessary. The nocturnal pollu- 
tions diminished in frequency but still occurred occasionally. 

" When M. J. B. consulted me in November, 1836, he presented 
the following conditions : Small stature, limbs slight and chest 
narrow, skin fair and soft, hair white and thin, face very pale, 
manner timid and embarrassed, hesitation, habit of stammering, 
arising from disorder in the intellect and loss of the memory, 
genitals remarkably small, penis small and short, hidden among 
long scanty white hairs, prepuce very long, forming numerous 
folds in front of the glans, surface of the glans covered by a 
thin layer of sebaceous matter, notwithstanding the utmost 
cleanliness on the part of the patient, scrotum compressed and 
much folded, containing only the right testicle, about the size 
of an almond, the left being felt in the inguinal canal attached 
to a portion of omentum. No spinal curvature (which the 
patient had feared,) his mistake arising from the projection of 
the hips and pelvis which resembled those of a woman. I re- 
moved the prepuce entirely in order to put an end to the in- 
fluence of the sebaceous matter on the glans ; catheterism not 
giving much pain, I did not consider cauterization necessary ; 
but in order to give tone to the organs I left a catheter in the 
bladder for an hour or two at a time once a week, and ordered 



152 SPERMATORRHCEA AND IMPOTENCE. 

the free use of cold douches to combat the constipation. The 
patient's temperament being exceedingly lymphatic, I after- 
wards prescribed three or four aromatic baths weekly, with the 
habitual use of spa water. 

" These means lengthened the periods between the pollutions, 
diminished the constipation, and lessened the involuntary dis- 
charges that took place when efforts at stool were considerable. 
Acupuncture of the perineum and prostate produced more 
rapid and decided effects. After this had been practiced, six- 
teen days passed without nocturnal pollutions, and the efforts 
at stool did not cause any seminal discharge. By degrees the 
patient's face became more healthy looking and animated, 
and his strength and energy returned ; his character regained 
its boldness and gayety, erections became frequent and energe- 
tic, and his health altogether having become as good as could 
be desired, M. B. returned to his home." 

There can be no possible doubt that a tight elongated 
prepuce is provocative of masturbation. The irritating secre- 
tions cause the child to finger his genitals when no persons are 
observing. That habit once commenced soon culminates in 
self-pollution. Circumcision is therefore a sanitary operation in all 
cases when phimosis exists. The earlier the operation is per- 
formed the better. The child's prospects of remaining free 
from a debasing and debilitating habit will thus be materially 
enhanced 

CHRONIC INFLAMMATION OF THE PROSTATE. 

Many cases of chronic prostatitis occur independently of sex- 
ual excess or masturbation. Prostatitis may run its entire 
course without loss of virility, or abnormal ejaculations of semen, 
yet cases are sufficiently numerous where the disease has pro- 



SPERMATORRHCEA AND IMPOTENCE. 153 

duced serious forms of spermatorrhoea and impotence to au- 
thorize a careful examination of them. The irritation which the 
disease excites in and around the prostate gland and the neck 
of the bladder, as well as in neighboring tissues, must necessarily 
affect to a greater or less degree, the seminal apparatus. The 
irritation, arising from the chronic distension of the blood- 
vessels of the gland and prostatic urethra as a consequence of 
the inflammation, acts in a similar way to the irritation excited 
by sexual excesses or masturbation, and is often followed by 
the same results, viz: frequent seminal losses, and a subsequent 
loss of virility. The following case in my own practice illus- 
trates this point : 

H. G., aet. thirty-five, contracted a gonorrhoea five years pre- 
vious to admission to the hospital. The discharge lasted six 
months. Afterwards there was a dull pain felt at the time of 
micturition, which continued a few moments after making 
water. At night there was a frequent desire to micturate, accom- 
panied with constant pain. 

At the end of a year the pain and frequent desire to mictur- 
ate had diminished somewhat, but he was troubled with noc- 
turnal emissions. They occurred three or four times each 
week and weakened him very much. At stool he said he some- 
times passed semen. This of course is doubtful. It was prob- 
ably nothing more than the secretion of the inflamed prostate 
with the addition of the secretion of Cowper's glands. He was 
less able to have intercourse, to perform the act. The erections 
were feeble and his ejaculations were premature. An examination 
of the urine showed the presence of a stringy mucus and a few 
pus cells. Its odor and reaction were normal. An examina- 
tion per rectum revealed the fact that the prostate was consider- 
ably enlarged, and tender on pressure, and some pain was pro- 



154 SPERMATORRHCEA AND IMPOTENCE. 

duced by the examination, which continued some time after the 
removal of the finger. The next act of urination also gave 
more pain than usual. So far as I could ascertain, there was 
no inflammation of the bladder. 

He was placed on an infusion of triticum repens, and quinine, 
and ordered to take two Turkish baths per week. At the end 
of six weeks I prescribed a weak solution of iodine to be paint- 
ed over the perineum every other day, and made him empty 
his bowels every morning by means of a cold water injection. 
He also took a cold sitz bath just before retiring, and had a 
brisk rubbing with a flesh brush. At the end of three months 
though the prostate was still enlarged, there was little or no 
pain, the frequent acts of micturition had ceased and his erec- 
tions were as healthy as they were before the inflammation 
commenced. 

Another case of a similar nature came under my care last 
winter. The patient was employed as a porter in a dry goods 
store. He was over forty, and said he had never abused him- 
self in any way, and only indulged in sexual intercourse at rare 
intervals. 

Twelve years before coming to consult me he contracted a 
clap, from which he recovered after six weeks' treatment. A 
year ago he again contracted the disease, and this time was not 
so fortunate, for the running continued for three months with 
little abatement. About a molith after it had ceased, he began 
to experience unpleasant sensations at the neck of the bladder 
during and after micturition, and the desire to pass water was 
frequent and urgent. There was also some discomfort at stool. 
As the fecal matter passed through the rectum, over the pros- 
tate, a whitish liquid escaped from the urethra. He consid- 
ered thi5 to be seminal fluid, because about this time he began 



StERMATORRHCEA AND IMPOTENCJE. 1^5 

to have painful erections and nocturnal emissions. The emis- 
sions occurred about four times each week, though he would 
sometimes, for a whole week, have one every night. Their 
effect was very depressing ; he lost appetite, became thin, and 
had but little sleep at night. 

The passage of the sound into the urethra gave great pain, 
and a desire to empty the bladder, as in the previous case. He 
did not attach much importance to the local pain or frequent 
micturitions. The seminal losses occupied his mind completely, 
and he felt that he was threatened with every imaginable evil 
from their occurrence. He improved considerably under treat- 
ment but he is not yet cured, and I think that the prostate 
will remain permanently enlarged. 

In all these cases of chronic congestion or chronic inflamma- 
tion of the prostrate complicated with seminal losses and impo- 
tence, the patient should be instructed that as soon as the local 
trouble is relieved he will be able to resume his procreative func- 
tion without anyfear of failure, and that the seminal losses are 
not due to any inherent weakness of constitution, or to anything 
that is likely to leave a permanent impression on his system. 
Thus re-assured, the remedies applied will have a ten-fold 
effect. 

If the patient is full-blooded, it will be well to use antiphlo- 
gistic measures at first. Cathartics in moderate doses may be 
given daily, for a week, so as to produce one or two extra eva- 
cuations in the day. Following this the perineum may be 
painted with iodine, or blistered, the patient of course remain- 
ing in bed during the time the blister is healing. It is well to 
follow the blister, when the new skin has formed, by an oint- 
ment containing mercury. I prefer the ordinary Ung. Hyd., 
to the others. It is less irritating, and will produce better 



t$6 Si»ERMAtORRHCEA AND IMPOTENCE. 

results. If the patient has a very sensitive skin, after the blis- 
ter ordinary simple cerate may be mixed with the blue oint- 
ment to make it still less irritating. During the application 
the gums and teeth should be carefully examined, and at the 
first symptoms of the constitutional effects of mercury the 
ointment must be discontinued. 

In addition the cold sitz baths described at page 230 should 
be taken once a day, at bed-time. The urine should be kept 
free of all irritating qualities by the remedies mentioned 
in the first case of prostatitis in this chapter. 

CHRONIC VESICAL CATARRH. 

Chronic vesical catarrh, by keeping up congestion and irri- 
tation in neighboring parts of the seminal apparatus, will 
sometimes be attended by frequent and painful emissions (as 
in prostatitis.) Though these seminal losses are often ignored 
by the surgeon, they seriously complicate the disease, retarding 
and perhaps preventing a cure. The cystitis itself produces 
sufficient pain and discomfort and mental distress, but when 
the additional weakness and the horror of impotence which 
every patient feels who is suffering from nocturnal emissions, is 
added, the case at once assumes a serious aspect, and nothing 
should be left undone to relieve the spermatorrhoea, while at 
the same time vigorous measures should be taken to cure the 
cystitis. The internal remedies recommended in prostatitis 
are also useful in cystitis, but there are others equally service- 
able, viz. eucalyptus, triticum repens, pareira brava, buchu, etc. 
Frequent washing of the bladder should never be omitted 
unless the operation should produce, as it sometimes does, 
intense discomfort and aggravation of the pain. After the 
washing I am in the habit of injecting two or three ounces of 



SPERMATORRHCEA AND IMPOTENCE. I57 

linseed oil, allowing the oil to remain in the bladder until the 
next urination. I have had better results from the use of 
linseed oil as an injection than from nitrate of silver or any of 
the numerous remedies used for that purpose. Where all the 
usual remedies fail to give relief, the operation of cystotomy 
should be performed. It is an operation attended with very 
little risk; is easily performed, and invariably gives relief. The 
pain ceases and the urine dribbles away without causing the 
patient any inconvenience. The bladder has a respite from 
the frequent contractions, and the patient has a chance of 
recovery given him, which he could not have obtained with- 
out it. 

The operation of lithotomy, especially the lateral one, is 
sometimes followed by impotence, and sometimes, although the 
cases are extremely rare, it follows cystotomy. The cause of 
this impotence I am unable to state. It could hardly arise 
from cutting the few filaments of nerves in the line of incision. 
The laceration of the ducts, by dragging out a large stone, may 
be the main factor. When impotence arises from these opera- 
tions there is Httle that can be done to cure the patient, who 
usually remains unable to copulate for the remainder of his 
days. 

MALFORMATIONS. 

Malformations which prevent sexual intercourse may be 
either congenital or acquired. They are not usually accom- 
panied with spermatorrhoea. Spermatorrhoea and impotence 
combined have been noticed in cases of hypospadias and epi- 
spadias. Morgagni mentions a case of the former malforma- 
tion in which there was sufficient irritation existing around the 
surface of the urethra and on its under surface near the margin 



158 SPERM ATORRHCEA AND IMPOTENCE. 

of the opening to cause ejaculations of semen three and four 
times each week. The constant seminal losses weakened the 
patient and destroyed his virility. It seems highly probable, 
however, that in this case there may have been some concealed 
lascivious habit which the physician failed to discover. Lalle- 
mand, quoting the same case, thinks there were other causes 
than the hypospadias at work in producing the pollutions. 

Lallemand says that " hypospadias has never been studied in 
reference to its connection with weakness of the organs. It is 
well known that Louis XVI. had hypospadias, and the memoirs 
of Madame de Campan leave no doubt that his marriage was 
not consummated for several years. I have met with one case 
of hypospadias in the hospital of St, Eloi ; it was accompanied 
with nocturnal and diurnal pollutions, but I only had an oppor- 
tunity of observing the patient for two or three days, and I 
cannot say decidedly that these pollutions arose solely from a 
natural weakness of the organs." * 

When hypospadias is accompanied by curvature of the penis 
the glans is usually bent downwards on the body. The 
enlargement consequent upon this altered form is generally 
sufficient to preclude intromission, and the patient becomes 
incapacitated for sexual congress. Epispadias may be con- 
nected with a similar curvature in an upward direction, which 
likewise occasions impotence. Curving of the penis in various 
directions sufficient to prevent penetration also arises from 
injuries and inflammations which destroy tissue. The new 
material formed to make up for loss of substance contracts 
like all other cicatricial tissue and the organ is consequently 
soon curved in the direction of the cicatrix. 

In October last I had a patient in Charity Hospital who had 
had chancroidal sores on and below the frenum. There was 



SPERMATORRHCEA AND IMPOTENCE. t^^ 

considerable loss of tissue by the ulceration, and much new- 
fibrous tissue in its place. The glans penis was bent down- 
wards on itself nearly at right angles, and could not be 
straightened. Erections occasioned great pain. Owing to the 
curved condition of the organ the patient had been unable to 
cohabit since the time he contracted the chancroids. I made 
an incision through the fibrous bands, straightened the organ 
and kept it in position until the wound healed. The patient 
was discharged cured. 

Cartilaginous formations in the fibrous septum, between the 
corpora cavernosa may produce similar changes in the slope 
of the organ and prevent intercourse. Gross speaks of having 
met with such cases of degeneration in elderly persons. The 
cartilage was deposited in patches, and interfered with erec- 
tions. 

Congenital absence of the penis necessarily involves impo- 
tence. A very small penis does not prevent either intercourse 
or procreation. Van Buren relates the case of a patient who 
had a penis about three-quarters of an inch in length. The 
man wished to have a child, and his physician advised him to 
have a glass tube prepared which would accurately fit the 
end of the penis. With this glass appendage he had inter- 
course with his wife and secured the wished for results. But 
artificial means are not necessary ; persons with but the stump 
of a penis left have been known to enjoy intercourse and 
impregnate women. All that is needed for conception is an 
injection of the seminal ^uid into the vagina. Once there it 
soon fulfills its mission, by finding its way to the ovaries. 

Van Buren and Keyes quote from Aupila the case of a man 
who was charged with rape by a woman who had conceived 
from the single intercourse, ^he penis of the man was almost 



l6o SPERMATORRHCEA AND IMPOTENCE. 

entirely gone — only a very small stump had been left. Hence 
it was decided that the concurrence of the woman must have 
been obtained before the act was consummated, or she would 
not have become pregnant, and that it was not a case of rape. 

A very large penis may prevent intromission and thus cause 
impotence. A double penis will do so likewise. 

Elephantiasic tumors of the prepuce, penis or scrotum, will 
render copulation impossible. Calculi in the urethra may be 
so large as to prevent intercourse. Gross quotes Sper, of 
Toulon, as having treated a patient who for upwards of thirty 
years was debarred from sexual pleasures by large calculi in the 
foreskin. And Dumeril mentions a case where a calculus 
weighing nearly six ounces imbedded itself in the urethral 
canal with like results. 

Extravasations of blood in the erectilQ tissue of the penis may 
cause impotence. The inflammation which follows the i e- 
moval of the blood closes the spaces in the erectile tissues, in- 
terferes with the entrance of blood into them and consequently 
destroys the erectile power. Gross speaks of a case related by 
Cullany, in which the patient, after indulging excessively in 
sexual intercourse, ruptured some portion of the erectile tissue, 
allowing the blood to escape into the meshes of the organ. The 
result was an erection which lasted a period of sixteen days. 
At the end of that time an incision was made, and a large 
amount of blood coagula burst out. The organ at once re- 
turned to a flaccid condition, and remained so, — the patient 
being rendered permanently impotefit by the subsequent in- 
flammation in the cavernous portions of the penis. 

Absence or atrophy of both testicles cause both impotence 
and sterility. The patients neither have the power of effecting 
penetration or of manufacturing semen. Where one testicle 



sperMatorrhcea and Impotence. i6t 

is left there is usually power to effect intercourse, and to pro- 
duce impregnation, though the latter is of rare occurrence. 

Extroversion of the bladder, a congenital condition in which 
the lower portion of the abdominal wall as well as the anterior 
wall of the bladder are absent, is necessarily a cause of im- 
potence and sterility in the male. It is not a cause of sterility 
in the female, as the functions of the vagina, uterus, and 
ovaries are not interfered with. 

PISORDERS OF THE RECTUM WHICH AGGRAVATE OR ORIGINATE 

SEMINAL LOSSES OR DISORDERS. 

Many writers on spermatorrhoea believe that certain disorders 
of the rectum, such as fissure, ulcer, stricture, or hemorrhoids 
may occasion the disease without the assistance of mastur- 
bation or sexual excess. The same authorities also attribute 
spermatorrhoea to the presence of pinworms in the rectum. I 
have seen in my own practice many cases where these disorders 
were aggravated by the spermatorrhoea, but I have not seen 
a case where disease of the rectum was the sole factor. It is 
reasonable to suppose that the affections in question produce 
congestion of the vessels connected with the prostate and 
seminal vesicles, and that the irritation resulting from these 
abnormal conditions may increase the number of seminal 
emissions, but I have never seen any cases of spermatorrhoea 
or impotence which were due solely to disorder of the rectum. 
They may, however, occur, and Lallemand has given several cases 
which are of great interest : 

Spermatorrhoea from stricture — " Nicholas G , the guard 

of a diligence, of a strong constitution, at the age of twenty-five 
contracted chancre, followed by bubo and warts. This attack 
of syphilis was treated with mercurials, without the patient 
II 



1 62 SPERMATORRHCEA AND IMPOTENCE. 

giving up his employment, and notwithstanding the fatigue 
consequent upon his frequent journeys, at the expiration of 
six weeks all the symptoms had disappeared. Shortly after- 
wards he experienced difficulty in defecation, which slowly in- 
creased so that in the course of four or five years considerable 
efforts were necessary to evacuate the rectum. The feces were 
flattened like a ribband, four or five lines in length and width 
and about a line in thickness. From this time G.'s health be- 
came greatly disordered, his appetite diminished, his digestion 
was impaired, and accompanied with the development of flatus ; 
he lost flesh and his weakness increased daily ; his memory was 
impaired, and the genital organs underwent the same changes 
in their functions. When he first consulted me he had scarcely 
any venereal desire ; his erections were imperfect, coitus was 
rarely possible, and ejaculation was long in taking place, — some- 
times it did not even occur at all, — and it was never accom- 
panied by any lively sensation. The concurrence of all these 
symptoms convinced me of the presence of spermatorrhoea. 
The patient told me that for four years he had been in the 
habit of passing semen while at stool, and that its discharge 
in general bore a proportion to the efforts necessary for the 
expulsion of the feces ; on this account, in order to render 
them as fluid as possible, he had reduced himself to a vegetable 
and milk diet. He had often attempted to use enemata, but 
had been unable to succeed. The abundant spermatic dis- 
charges had so worn this patient out that at the age of thirty- 
four he presented the appearance of a man of sixty. On ex- 
amination, I discovered about two inches from the anus a 
nearly circular obstruction of about half a line in thickness, 
having an irregular opening in its center which would barely 
admit the extremity of the forefinger. This kind of diaphrasjm 



SPERMATORRHCEA AND IMPOTENCE. 163 

obstructed the passage of fecal matter ; it was thin and soft, 
and felt like a cicatrix. I made transverse incisions through 
the obstruction by means of a straight probe-pointed bistoury 
passed along the index finger. These incisions were of very 
trifling depth, and I afterwards dilated the opening by intro- 
ducing my finger deeply and pressing it forcibly in the direction 
of each wound until by tearing I reached the walls of the in- 
testines. 

" Four loose flaps resulted from this operation and I prevented 
their re-union by the frequent introduction of my finger. The 
operation was attended with very little pain or loss of blood. 
Some time afterwards I showed the patient how to introduce a 
cretum bougie, of sufficient size to dilate the portion of gut 
which had been operated on ; this I advised him to practice 
daily for some time. 

" This simple means proved sufficient to procure separate cica- 
trization of the four flaps, after which the expulsion of the 
feces took place without difficulty, and the spermatic discharges 
ceased. All his functions were soon restored to their natural 
state, and Nicholas G. resumed his former occupation." 

" M , of good constitution, entered the army at the age of 

seventeen, and served for eighteen years, during which he was 
exposed to considerable hardships. He also committed ex- 
cesses of all kinds. His health, however, continued excellent. 

In 1 8 14, M , then aged thirty-five, contracted blennorrhagia 

which he neglected ; the discharge diminished, but did not en- 
tirely cease before 1816, when he quitted the army. In 1820, 

M married, but did not indulge in any excesses. Some 

time afterwards, having been engaged as concierge to a club, 
he passed many nights almost without lying down. In 1824 he 
was suddenly seized with violent colic^ which was relieved by 



if 4 s?ermator?.h:ea avd ivpcrzvzE. 

means of em:" lient injections, repeated ';:.: .s. ini a severe 
regimen, bi:: vrh::h did not entirely leave him. Two years af- 
terwards he hsd a severe heiiirrhage from the rectum, accom- 
panied with very painfii". :r: r_: . 5 during the violent spasms 
of which he noticed tha: --e i:£5ti semen. This hemorrhage 
relieved the colicky p^^ins he ii=d 5 ifered from, but a dysentery 
remained, which kept up the Tenesmus ar.! — Ith it the involun- 
tary seminal emissions, and c : u _ t i : t - 5 r : :' several hem- 
orrhoidal tumors with eversien ci ;he m : ::- mfm-brane of 
the rectum. From this period M.'s heal:/, i^;. r more and 
more disordered ; he lost his habitual spirits together with his 
sexual appetite, and his sirht as ~r e his memory and phjFsi- 
cal strength became "e.he-ri 5: i??7 he was obliged 
to give up his occnp 1::; u ; : : : :.::-: ^z I hng the years 1827 
and 1828, the chronic diaixhit 3. de mease d in severiry, and in 
1829 it had become much less fre: aen:. A: iermh in 1830, it 
was replaced by a very ::sTm-:e mmri-mdm \ i:hini:stum 
also became the cause :: 5 ;: : hit;, aai inireasei the 
swelling caused by the htm m:h ; i as ana the prolapsed mucous 
membrane of the rectam. 7.5 ; t iina 'vas irreducible ; it in- 
creased in hardness as i::m m a : :he :'ri:r*on of his dothes, 
and at last ass am e a a s irraias mnsismniv. Its presence 
also formed a considerable obstacle :: aefeiation. On the 28th 
of March, 1831, M. applied at the Lie ial S:. El. in the fol- 
lowing condition ; He m fifty-one ears :i ape : extremely 
pale ; his face p le rii: : skin muda p : hair :la:h : —emaness 
excessive; sen; : i : erv rreat : prrnana melancholy; 
habitual hypochondriasis : digestion diniaal:, especially after 
the nse of animal food ; defecation ren aere a :: : a : les ame by a 
red hard swelling, five or six lines in di me:e: a::: ss its base, 
pr; ecaap about an inch, and occupmaa a a: hai: ::.z :i::um- 



SPERMATORRHCEA AND IMPOTENCE. 165 

ference of the anus ; involuntary discharges of semen during 
the efforts necessary to procure a fecal evacuation ; the emis- 
sion of urine followed by a discharge of a glairy, limpid, and 
sticky matter ; no erections during a long period ; absence of 
all sexual impulse ; frequent attacks of vertigo ; dazzling of the 
eyes ; buzzing in the ears ; attacks of heat towards the head 
from the sHghtest cause. The tumor of which I have spoken 
resembled a large cock's comb ; contracted hemorrhoids were 
situated around it ; and it seemed to have arisen from the pro- 
lapsus of internal hemorrhoids, which had brought down with 
them a portion of the mucous membrane of the rectum. The 
contraction of the sphincter ani had prevented the return of 
this tumor and had increased its swelling, and the friction of 
the patient's clothes had caused repeated inflammation and de- 
generation of its tissue. The base of the tumor occupied more 
than half the circumference of the anus, and extended above 
the sphincter ani. It was about six lines in thickness, and its 
feel was scirrhous ; a sanious discharge exuded from its sur- 
face, some points of which had even begun to ulcerate. It 
was, therefore, evident that no time should be lost if it were in- 
tended to remove this tumor ; the patient was anxious for the 
operation, and had previously asked several surgeons to perform 
it ; but the gentlemen had refused on account of the depth to 
which the diseased tissue extended. By gentle and gradual 
traction on the tumor I was able to bring it entirely through the 
sphincter, so as to bring the healthy mucous membrane into 
view. On the 25th of March, therefore, I comn:.enced its re- 
moval by an incision in the healthy mucous membrane, and to 
arrest the severe hemorrhage which ensued, I cauterized the 
bottom of the wound with a fine heated iron. The tumor was 
then dissected out, the parts being touched with the actual 



1 66 SPERM ATORRHCEA AND IMPOTENCE. 

cautery as they were divided. After the entire removal of the 
tumor, the greater portion of the wound ascended within the 
sphincter. Slight inflammatory symptoms supervened, which 
yielded to bleeding, etc., suppuration was established, and the 
cicatrization of the wound was completed by degrees. The 
first few days after the operation the patient was unable to 
void his urine without the use of the catheter, and for some 
time afterwards he micturated very frequently. On the first 
of May, cicatrization was nearly completed, the feces had re- 
gained their normal consistence and were passed daily without 
difficulty, their passage no longer giving rise to involuntary 
spermatic discharge. The patient regained his health and spir- 
its ; his appetite returned, and his digestion was performed 
easily ; his strength and stoutness increased daily. About the 
middle of the month his erections reappeared during the night, 
and afterwards became more frequent and prolonged ; his 
cerebral functions followed the same course in their re-estab- 
lishment ; the dazzling of sight and cerebral congestions dis- 
appeared ; and M. left the hospital on the 24th of May, per- 
fectly restored to health. Three years afterwards, when I was 
summoned to Clermont to preside over a medical inquiry, M. 
called on me ; I recognized him with difficulty, so much was his 
countenance changed. It is scarcely necessary for me to say 
that he had resumed his conjugal duties, and his occupation of 
concierge. The cicatrix of the anus was thin and soft, and did 
not interfere with defecation." 

These exceedingly interesting cases are given in detail be- 
cause I have not had any such cases in my own practice, and 
other authorities that I have examined fail to give them more 
than passing mention. Even allowing for the pardonable coloring 
of an enthusiast Jike Lallemand, it can readily be seen that the 



SPERMATORRHCEA AND IMPOTENCE. 167 

rectal troubles described were very important factors in the pro- 
duction of spermatorrhoea and impotence. 



SPERMATORRHCEA AND IMPOTENCE FROM NARCOTICS AND OTHER 

FORCES. 

Narcotics, such as tobacco, opium, etc., possess a decided 
influence over the genital function. Tobacco possesses in some 
cases decidedly irritable qualities and in persons with relaxed 
genitals may produce increase in the number of pollutions. In- 
deed in all cases of genital irritation it does an immense deal of 
harm, but I have never yet met with cases of spermatorrhoea and 
impotence which were entirely the result of use of this drug. 
Lallemand gives several. 

" M. S., of Stockholm, short and stout, and of lymphatico-san- 
guineous temperament, enjoyed excellent health from childhood, 
until, at the age of sixteen, he entered a tobacco manufactory 
in May, L835, and was employed in a small room where newly 
made cigars were dried at a high temperature. At least ten 
thousand cigars were constantly in the stove. At first M. S. 
did not suffer any inconvenience, because the doors and win- 
dows of the drying room were left open; but about the beginning 
of November he was attacked by headache, which was felt princi- 
pally behind the ears. This increased by degrees in severity 
and duration, and by the end of the winter had become con- 
stant; the patient was neither able to employ himself during the 
day, nor to sleep by night. Leeches were applied behind the 
ears, and on the following day he was seized by general indis- 
position, frequent vomiting, as well before as after meals, dila- 
tation of the pupils, and constipation. 

" From this time the patient fell into a profound melancholy; 



1 68 SPERMATORRHCEA AND IMPOTENCE. 

he became exciteable, timid, and incapable of any serious oc- 
cupation. A seton was inserted in the nucha and the applica- 
tion of leeches was repeated. No improvement took place, 
however, and blisters were applied behind the ears ; these 
were followed by retention of urine. Soon afterwards, weak- 
ness of the lower extremities, loss of flesh, and pallidity of the 
countenance were added to the patient's other symptoms. 

" The mineral springs of Carlsbad and Ems, and the use of 
sea bathing, with cold douches on the head, relieved the vom- 
iting, but the other symptoms still continued. In this condi- 
tion the patient came to consult me in July, 1836. From 
information received from the medical gentlemen under whose 
care the patient had been at Stockholm, Paris, etc., I imagined 
the sea bathing had been the most useful of all means pre- 
viously tried. 

" I therefore advised M. S. to continue taking salt water 
baths until the end of the season, and consequently I did not 
see him again until the beginning of winter, when his weakness 
was much increased, his headache continued unrelieved, his 
countenance was pale and livid, his intellect very sluggish, his 
memory uncertain, his sleep short and broken, with constant 
drowsiness, the pupils extraordinarily dilated, and vision very 
imperfect ; in fact the patient seemed to be still laboring under 
the effects produced by the cigar stove. The pfimary cause of 
this patient's condition could not be doubted ; but the effects 
of narcotic poisons usually pass off in a day or two. In this, 
on the contrary, the headache had been combated by various 
means for two years. I 'was, therefore, considerably embar- 
rassed as to what I should advise, when accidentally I saw the 
patient's urine. I was m.uch surprised to perceive an abundant 
deposit resembling semen at the bottom of the vessel and on 



SPERMATORRHOEA AND IMPOTENCE. 169 

questioning M. S. I learned that although he had never been 
addicted to masturbation, and had very rarely had sexual in- 
tercourse, shortly after the symptoms of narcotism first con- 
fined him to his bed, he had experienced abundant nocturnal 
pollutions which decreased in frequency, so that he had then 
only three or four weekly ; he remarked that he was alwavs 
worse on the following day. At first those pollutions were ac- 
companied by energetic erections and lascivious dreams ; but 
these phenomena had greatly diminished and the pollutions 
were no longer appreciable except by the marks left on the 
patient's linen. For a long time M. S. had neither exper- 
ienced venereal desires nor erections, although he was only 
nineteen years of age. Spa water, iced drinks, cold lotions, 
etc., having produced no benefit, in the beginning of Decem- 
ber, I introduced a catheter. The sensibility of the urethra 
was such that I determined on cauterizing the prostatic sur- 
face. I had little hope of benefit arising from this operation, 
but a remarkable effect was produced. From that moment the 
nocturnal pollutions became more and more distant and the 
constipation ceased spontaneously. On the tenth day the 
patient's urine was perfectly transparent, and from that time his 
headache, which had been unsuccessfully treated for two years, 
disappeared entirely, his sight became gradually stronger and his 
pupils contracted, his ideas became clearer, employment was 
sought and M. S. was soon able to resume his occupation. 
His virility returned with great energy ; during six months 
obstinate erections were established every night, and often 
during the day on the least cause of excitement, but no invol- 
untary discharges took place. These violent erections arising 
from the unaccustomed retention of the semen in its reservoirs 
diminished by degrees, the wants became less imperious and 



lyo SPERMATORRHOEA AND IMPOTENCE. 

the functions returned to their normal condition. I have seen 
M. S. frequently since his recovery, and I am able to state 
that during two years his health has been perfect. In a letter 
which I have recently received from him. dated Stockholm, he 
informs me that the change of climate has not been injurious, 
that he has never enjoyed better health. He has resumed 
the habit of smoking, for which he felt insurmountable disgust 
during his illness." 

*' I have a young man of very nervous temperament at present 
under my care, in whom nocturnal and diurnal pollutions have 
brought on pain in the loins, palpitation, difficulty of breathing, 
etc., symptoms which were supposed to arise from disease oi 
the spinal cord, cardiac affection, and commencing phthisis. 
Among the exciting causes of these involuntary discharges, the 
effects of smoking occupy the chief place. The following is 
the patient's statement : * At twenty years of age I wished to 
accustom myself to smoking, but a day never passed without 
my experiencing complete intoxication, attended with vomiting, 
vertigo and trembling of the limbs. I continued the habit, 
however, and I soon began to perceive that my sight became 
weak and that I lost my memory, my hands shook, and my di- 
gestion became much disordered. I noticed, also, great de- 
bility of the genital organs, my erections ceased and at the age 
of twenty-two I found myself completely impotent.' 

" This patient had rarely practiced masturbation, and had 
never committed any excesses when he first began to smoke : 
his health had, previously, been excellent. It is, therefore, 
evident that the impotence as well as the other symptoms 
arose from the action of tobacco. Impotence at the age of 
twenty-two can only be produced by involuntary seminal dis- 
charges, provided there be no physical disability. In the 



SPfeRMAtORRHCEA AND IMPOTENCE. 17I 

present case there was no doubt on the point, the patient hav- 
ing discovered diurnal and nocturnal pollutions.** 

*' A professor, ^t, thirty, engaged in a new method of tui- 
tion, had recourse to very strong coffee to keep himself awake, 
and took eight or ten cups every night. A large quantity of 
urine was secreted, and micturition was much increased in 
frequency. After a few weeks the desire to empty the bladder 
became so frequent and imperious that the patient was obliged 
to leave his class several times during their meeting. Soon 
after he suffered from constipation and disordered digestion, 
attended with great discharge of flatus. His intellect and 
memory declined, so that he became unable to finish his course 
of instruction, and sleep had left him entirely, although he had 
for some time given up taking coffee. 

" On his consulting me, he confessed that he had become 
completely impotent, after having experienced frequent and 
abundant nocturnal pollutions, which diminished by degrees, and 
had not appeared for three months. I found his urine per- 
fectly transparent, — almost colorless, — and very abundant. 
There was not the least cloud perceptible, but at the bottom of 
the vessel there were numerous transparent granules, which 
left no doubt as to the existence of diurnal pollutions. Cathe- 
terism showed excessive sensibility of the urethra, especially 
near the neck of the bladder ; and on this account I performed 
cauterization. The operation was followed by rapid improve- 
ment, and a few months afterward the cure was effected by the 
use of sulphuretted springs.** 

The same author reports cases of spermatorrhoea arising from 
the use of camphor, ergot, cantharides, iodide of potassium, etc. 
If these drugs are capable of inducing this disease it must be 
merely temporary, and a healthy state would be recovered when 



1^2 SPERMAtORRHCEA AND IMPOTENCE. 

the effects of the poison had passed away. In my own prac* 
tice I have not found any such cases. 

CALCULI IN THE PROSTATE GLAND. 

Small concretions occurring in the prostatic ducts excite a 
degree of irritation sufficient to produce in persons of average 
health frequent nocturnal, and even diurnal, emissions. The 
irritation may be even so great as that which exists in com- 
firmed masturbators. After the concretion has been removed, 
it may leave behind inflammation and ulceration in the ducts 
which will keep up, for a length of time, the emissions of sem- 
inal fluid. 

I know a married man who treated himself for gonorrhoea 
with a strong solution of acetate of lead. He forced the solu- 
tion, by injection and pressure with his fingers, to the neck of 
the bladder. A few moments subsequently he had a curious 
feeling of distension in the prostatic portion of the urethra. 
The feeling of distension then changed to a sensation which 
he said was like a moderate orgasm accompanied with pain. 
The irritation which this peculiar feeling occasioned was so 
great that he could not sit still one minute. At night he was 
troubled with emissions, which were always painful. Micturi- 
tion was frequent, and at its termination there were violent 
expulsive movements of the muscles and straining at the 
neck of the bladder. Two weeks from the time the injection 
of lead was used, he got up at night to empty his bladder, and 
after great straining forced out a half-teaspoonful of a material 
which was hard and gritty and about the consistency of plas- 
ter. With the passage of the calcareous mass the irritability 
and pain and emissions ceased. The patient thought that the 
lead had occasioned a precipitation of calcareous salts in the 



SPERMATORRHCEA AND IMPOTENCE. I73 

prostate or ejaculatory ducts, or sinus pocularis, and that this 
was the whole cause of the trouble. The concretion came 
undoubtedly from some portion of the prostate. Whether it 
had anything to do or not with the injection of acetate of lead I 
am unable to say. 



CHAPTER IX. 

DISEASES THAT RESULT FROM SEXUAL EXCESS AND MASTURBA- 
TION. 

Cerebral Anaemia — Symptoms and Course — Peculiarities of Cerebral Anaemia 
in connection with Excess — Spasmodic Contraction of Voluntary Muscles 
in Connection with Anaemia — Termination in White Softening — Signifi- 
cance of Loss of Memory — Local Paralysis — Effects of Hemorrhage into 
the Cerebellum — Sclerosis of Nerv^e-Fibres of Cerebellum — Hanging — 
Concussion of the Spinal Cord — Softening of Spinal Cord — Impotence 
from Sunstroke. 

CEREBRAL ANAEMIA 

Is of common occurrence among those addicted to masturba- 
tion and sexual excess. It is more likely to occur in such per- 
sons when the digestive organs are. out of order and the power 
of assimilation feeble. Add to these a condition of impover- 
ished blood and we have all the necessary elements for attacks 
of cerebral ansemia, which, in such cases, may occur suddenly 
when the stomach and intestines are distended with gas. 

It is ushered in with vertigo and dimness of vision. The 
patient may drop suddenly on the floor in a " fainting fit," and 
become partially or completely insensible. The face is deathly 
pale, the pupils are dilated, and the pulse thready or altogether 
absent. In some cases there may be spasmodic contraction for 
a short duration, — of the voluntary muscles. I have seen these 
spasms in those who had cerebral anaemia from protracted hem- 
orrhages. In some cases the patients have what they call a 
'' lost feeling," which appears with a dazed expression of coun- 



SEXUAL EXCESS AND MASTURBATION. l^^ 

tenance, with pallor, and though able to retain the erect or sit- 
ting position, they are partially unconscious. The effect soon 
passes off, and the patient seems to be as well as before the 
attack took place. 

With reference to cerebral anaemia, Jones has the following : 
" The diagnosis of cerebral anaemia is evidently a point of the 
highest importance, and one which may, by no means, be always 
easy. When the face is pale, the scalp cool, the eyes uninjected, 
the general circulation quiet, when there is no appearance of 
cerebral excitement but rather of failing power, when the 
recumbent position affords relief, and the distressing sensations 
in the head are described as a weight at the vertex, or a feeling 
of opening and shutting, and as if the top of the head were 
being lifted off, — the nature of the case is clear. But there 
may be conditions of the most marked general anaemia or span- 
semia, in which, of course, the cerebral circulation participates, 
and yet in which there may arise terapprarily a state of cerebral 
hyperaemia. By this I mean that though the blood is evidently 
of very imperfect quality, deficient in solids and in red cells, 
and that an excess of this blood is sent to the brain above what 
it ought, under the circumstances, to receive. Nothing is more 
common than to find anaemic patients complaining of headache 
from the administration of necessary tonics, because their ner- 
vous centres have been brought into such a state of hyper- 
aesthesia by their impaired nutrition that they can hardly toler- 
ate anything of a stimulant nature. A little excess, therefore, 
even of spanaemic blood, may cause distress to a feeble brain, 
which, after it has regained more healthy tone, will bear and be 
benefited by a larger amount of much better blood. The case 
is similar to that of the starved man, whose very preservation 
depends on his being fed most sparingly for some time. 



I*j6 SEXUAL EXCESS AND MASTURBATION. 

Cerebral anaemia may terminate in chronic softening of the 
brain, usually denominated white softening. The affection 
may commence without any marked attacks of cerebral 
anaemia. When it arises as a concurrence of venereal excess 
or masturbation it is usually insidious in its onset. Though I 
have not seen any cases where the cause was directly attribut- 
able to these malpractices, there are enough of them on record 
to make the matter certain. The softening is probably the result 
(as it is the* cause) of general mal-nutrition, which, owing to 
the excessive waste of nerve force consequent upon the vice, is 
first felt in the nerve fibres before it has established itself else- 
where. One of the first symptoms is a failure of memory. The 
patient drops in the middle of a sentence and forgets the bal- 
ance. There is a mental blank for the time being, and only by 
an immense effort can the conversation be resumed. But it must 
be remembered that forgetfulness and spasmodic mental blanks 
are often occasioned by "brain fag" from overtaxed brain, 
from mental worry, and also from various forms of dyspepsia. 
It is not safe therefore to attribute the failing mentality in all 
cases, nor indeed in the majority of cases, to white or chronic 
softening unless there are other corroborative signs. If there 
is a diminished sensibility and loss of power in the extremities, 
together with loss of memory, then we may conclude that the 
disease is present. Chronic softening of the brain and of the 
cord are both curable if taken in the early stages. The treat- 
ment will be described in its proper place further on. 

In addition to the general tonic treatment recommended in 
chapter XIV patients suffering from anaemia of the brain and 
cord or softening of a portion of either, arising from excess or 
masturbation, should receive hypodermic injections of strych- 
nine -^ff of grain daily unless unpleasant effects are produced 



SEXUAL EXCESS AND MASTURBATION. I77 

by the drug. Even when they make the patient uncomfortable 
a day or two's abatement from the drug may enable him to bear 
it better afterwards. Small doses of opium have also been 
recommended, but I should dread the effect on the stomach. 
Vigorous massage is beneficial in all cases. 

HEMORRHAGE IN THE CEREBELLUM — SCLEROSIS — SOFTENING 

AND CONCUSSION OF THE CORD, ETC. EFFECTS OF 

HANGING, ETC. 

Other diseases of the brain and cord are ushered in and 
accompanied by frequent ejaculations of seminal fluid. Many 
of the cases are accompanied by impotence, others develop 
erotic desires, satyriasis and priapism. Diseases of the cere- 
bellum are peculiarly liable to induce derangement of the gen- 
ital functions. Sclerosis of the nerve fibres of the cerebellum 
is sometimes marked by nocturnal and diurnal emissions and 
severe cephalalgia referred to the occiput. In one case of par- 
tial cerebral sclerosis which involved a small portion of the 
cerebelliim the patient suffered from frequent emissions before 
any symptoms of cerebral trouble manifested themselves. Co- 
incident with manifestations of the sclerosis, the pollutions 
were increased in frequency, and as the disease progressed 
were of daily and nightly occurrence. The erectile power was 
good in the early stages and an erection accompanied each 
emission, but as the disease progressed the patient gradually 
became impotent, and all power of cohabitation was com- 
pletely lost. 

Hemorrhage into the cerebellum may produce a similar con- 
dition ; usually, however, hemorrhage into that portion of the 
brain causes priapism, a condition which is characterized by 
constant erection with little or no desire. Serres gives the his- 
12 



178 SEXUAL EXCESS AND MASTURBATIOisf. 

tory of eleven cases of hemorrhage, six of which were affected 
with priapism. Tumors in the same region have been known 
to cause priapism in some and in others spermatorrhoea and 
impotence. 

It is well known that persons who have died from hanging 
have had seminal emissions during the death struggle. And 
cases are recorded and well authenticated also, in which tem- 
porary suspension of the body by means of a rope around the 
neck has been resorted to by masturbators to produce the 
orgasm and ejaculation of semen. 

Concussion of the spinal cord has been known to produce 
persistent priapism in some cases and spermatorrhoea and 
impotence in others. When the principal seat of injury is 
located near the genito-spinal center of the cord the latter con- 
dition will probably prevail. Lallemand relates the case of a 
French soldier who, while attempting to climb to the room of 
his mistress, fell a considerable distance to the ground striking 
on his sacrum. Paralysis of the lower half of the body soon 
showed itself, and afterwards there was a priapism. His erec- 
tions were constant. He endeavored by masturbation to 
relieve the painful distension of the penis, but without avail. 
He then went to his mistress and thought to relieve himself by 
intercourse. Though he tired the woman out he obtained no 
relief. His efforts in every instance failed. He had neither 
discharge of seminal fluid nor an orgasm while in her com- 
pany. Still, strange to say, when alone and asleep in his own 
apartments he had both emissions and pleasurable sensations. 

Acton mentions the case of a young clergyman who was sub- 
ject to priapism from the slightest irritation. Walking, riding, 
even the friction of the trowsers would produce erection. Dr. 
Acton found that the trouble was partly due to a very tight pre- 



SEXUAL EXCESS AND MASTURBATION. 1 79 

puce, and by stripping the glans and frequent ablutions the 
patient was very quickly improved. I have seen a similar case 
in a clergyman suffering from malaria and slight prostatitis. 
Whenever he had occasion to make water he had powerful 
erections which were not relieved by emptying the bladder, but 
continued for two or three hours afterwards. By a judicious 
use of bromide of potassium and hot sitz baths he was very 
much relieved, and when the malaria was cured the priapism 
ceased. I have also noticed in two cases, where the patients 
had been indulging their venereal appetites to excess, that a 
priapism lasting several hours at a time was the commencement 
of their impotence, but in this variety of priapism there seems 
to be no loss of desire while the condition lasts, and they 
indulge themselves at every favorable opportunity. In one of 
these cases there was no recovery. Progressive locomotor 
ataxia was at one time supposed to arise from inordinate 
sexual congress and onanism, but that belief has to a 
great extent been abandoned. Many cases of the affection 
occur in persons who have lived temperate lives, and who have 
shunned excess in every form. However a majority of the 
patients suffering from locomotor ataxia have spermatorrhoea 
of a troublesome nature. In the latter stages of the disease 
there is complete loss of the virile power. In the cases which 
are preceded by spermatorrhoea the disease is of a more serious 
nature, is more apt to run a rapid course and reach a fatal 
termination. 

Other diseases of the spinal cord, such as white softening, 
tumors, and injuries, such as dislocations and fractures of the 
vertebrae, implicating the cord, are all accompanied by some 
disarrangement of the genital functions. In some instances, 
they are characterized by frequent ejaculations of semen and 



l8o SEXUAL EXCESS AND MASTURBATION. 

loss of virility, in others priapism and aspermatism are present. 
In injuries which produce a certain amount of irritation and 
inflammation the latter conditions are more likely to be present, 
while in anaemic conditions, or chronic softening, seminal emis- 
sions and impotence are usual. Chronic or white softening of 
the spinal cord may arise as a result of masturbation and sex- 
ual excess. The nerve fibres of the part affected show first a 
coagulation of the white substance of Schwann, then segmenta- 
tion of the nerve fibre, and finally granular degeneration and 
breaking up of the nerve fibres and softening of the whole part 
affected. The disease is apt to pass unnoticed until there is 
more or less loss of power, and some loss of sensation in the 
lower extremities. In its inception there is diminished sen- 
sibility in the different portions of the extremities, usually, the 
toe. The patient feels that the spot is numb, and that the toe, 
or the spot afi'ected, is not so moveable as it was before the 
disease. The paralysis becomes more and more marked as the 
months go by, for it must be borne in mind that the disease 
runs a very slow course until the paraplegia is complete, and 
the patient is unable to move his lower extremities or feel any 
sensation to any extent in them. He is then confined t-o bed. 
There is retention of urine, and the urine must be drawn off 
with a catheter two or three times each day. With all possible 
care exercised in keeping the bladder clean by frequent wash- 
ings, cystitis is soon developed by the irritating urine, which 
adds much to the pain and general discomfort of the patient. 
I had a patient in Charity Hospital a few years ago, who had 
softening of the cord supposed to be due to excess of one kind 
or another, who suffered very great pain from his cystitis, 
which was increased by every washing. Even large doses of 
morphia failed to relieve him, given by the mouth and hypo^ 



SEXUAL EXCESS AND MASTURBATION. l8l 

dermically. I was finally compelled to resort to cystotomy, 
which afforded a free outlet to the urine, and allowed his blad- 
der to be washed without causing any special inconvenience. 
The operation relieved him completely of the pain and dimin- 
ished the amount of his cystitis to a very appreciable degree. 

SUNSTROKE. 

Sunstroke i« frequently a cause of spermatorrhoea and im- 
potence. These disorders are more likely to appear in the 
congestive forms of sunstroke than in that variety character- 
ized by exhaustion or syncope. The genital derangement 
shows itself when the headache, vertigo, dimness of vision and 
other accompaniments of the disease disappear. Soon after 
the patient begins to exercise, frequent emissions occur which 
aggravate to a great degree the already existing mental depres- 
sion. With the emissions there is always a loss of virile power, 
though the loss is not complete till a later period. In these 
cases there must be some organic change in the encephalon, 
the direct result of the coup de soliel, which interferes with the 
genital functions. This is shown by the persistence of the local 
affection in spite of all treatment. 

In my own practice I have only met with one case of impo- 
tence from sunstroke. I have heard, however, of three other 
cases which were under the care of other physicians. The 
patient referred to was a man in robust health, full blooded 
and muscular, a free eater and drinker, and previous to his 
attack had indulged very freely in sexual intercourse. From 
his boyhood to the age of thirty-nine (at which time he was in- 
jured), he had never had the slightest inconvenience or illness 
from it. At the time the sunstroke occurred his genital func- 
tions were perfect in their action. Three weeks subsequently, 



t82 sexual excess and masturbation. 

when he seemed to have completely recovered from the injury, 
he attempted cohabitation with his wife, but was not success- 
ful. Consecutive trials soon convinced him of his complete 
incapacity for sexual intercourse. When I saw him twelve 
months afterwards he seemed to be in perfect health, but he 
had no control over his genitals. Desire was present, just as 
much as ever, but there was no attempt at erection, and the 
ordinary methods of treatment availed him but little. 



CHAPTER X. 

CONTINENCE. 

Fulfillment of Function Necessary to a Healthy Organization — Impairment 
of Function as a result of Disease, or Inaction — Results of Suspending 
the Function of Joints, Muscles, Eyes, etc. — Loss of Sight in Animals 
Secluded from the Light — Changes in Genital Organs from Continence — 
Reasons Why Continence is Likely to Cause Spermatorrhoea and Impo- 
tence — Cases where Impotence Existed Independently of Spermatorrhoea 
and Latter without Impotence — Where Continence Produces these Dis- 
eases, and Marriage is not Attainable what Advice Should be Given by 
the Physician — Responsibility of the Medical Adviser — Novel Aspect of 
the Case — Views of Clergymen on the Subject and their Advice — Opin- 
ions of Acton and Others. 

Nature intended that every organ in the human body should 
perform some special physiological duty. To each atom a task 
is assigned. The normal action of one part is necessary for 
the healthy action of another. Though independent in func- 
tion, the mutual performance of nature's task is necessary for 
the harmony of the whole. Fulfillment of function is indis- 
pensable to development, and to the maintainance of a healthy 
standard. There is no exemption from this law. 

Whenever, through disease or neglect, an organ fails to ac- 
complish the object for which it was intended, its functions be- 
come impaired, and may even be altogether destroyed. When 
the movement of a joint is interfered with by splints, or other 
surgical appliances, for any great length of time, the synovial 
fluid diminishes, the smooth surface of the synovial membrane 
becomes dryer and rougher, and the ligaments become thicker. 



184 CONTINENCE. 

The movements of the joint are very much impaired by these 
changes,and if the immovable condition should be continued for 
too long a period permanent anchylosis of the joint surface 
would take place, with entire loss of movement. When m^us- 
cles are maintained in a quiescent state by paralysis or by me- 
chanical appliances, the muscular fibriilse undergo fatty degen- 
eration. Atrophy of the muscle soon follows, with complete 
loss of the power of contraction. If the eyes are not employed, 
diminished ocular perception and even total blindness will 
occur. This is often witnessed in young animals confined in 
darkened places, or where there is an entire seclusion from 
light. Fishes living in caves where no light enters lose their 
sight rapidly. In the tanks of the New York aquarium many 
of the fishes were rendered blind from the same cause. Most 
of the old ones had very large opacities of the cornea. 

The genital organs are not exempted from the general law, 
viz : that the neglect to fulfill a function may be followed by a 
loss of power to perform that function in a natural manner. It 
is true that a man may go for years without intercourse, may 
then marry, and be able to copulate with success ; but such 
cases are exceptional. The organs of generation were intended 
for the propagation of the species during adult life, and the 
performance of their functions in the married state conduces to 
a healthy condition of mind and body. Every man with a 
healthy organization should be married before the age of 
twenty-four. 

Sexual debility is far more frequent among men who marry 
after the age of thirty-five than it is among those who marry young, 
and failure occurs earlier. I think it is not advisable for a 
marriage contract to be made before the age of twenty-four un- 
less there should exist some special disorder of the genitals 



CONTINENCE. 185 

which may be benefited by such a course. The questions may 
be asked, why define as a limit the age of twenty- four ? Are 
the genitals not active and ready to fulfill their physiological pur- 
poses soon after the age of puberty ? It is true that the age of 
puberty is the commencement of entirely new conditions, and 
it would be possible for the organs to be employed in the fulfill- 
ment of their natural function ; but I believe that while the 
development from youth to young manhood is going on^ 
while the tissues are in process of development for the more 
active life of maturer years, sexual intercourse would probably 
retard that growth and development. When the youth has 
reached his full growth, then, is the time for him to indulge in 
legitimate sexual intercourse ;' then the nervous impressions due 
to repeated orgasms will do little or no harm, unless there is 
great excess. 

With the boy who has been free from bad habits and who is 
thoroughly educated as to the necessity of holding the sexual 
appetite in abeyance up to a certain age, so that he may become 
a perfect man, there will be little difficulty in preventing im- 
proper intercourse or legitimate intercourse before the time 
stated. 

Acton says : " An almost infinite variety of opinion exists 
on this subject, between the extreme proposition on the one 
hand, that a young man has, or need have, no sexual desire, at 
least to any troublesome degree, and consequently need neither 
take precautions, nor be warned against the danger of exciting 
his sexual feeHngs ; and the equally extreme doctrine on the 
other hand, that the sufferings of chastity are such as to justify, 
or at least to excuse, incontinence. My own opinion is, that 
where, as is the case with a very large number, a young man's 
education has been properly watched, and his mind has not 



1 86 CONTINENCE. 

been debased by vile practices, it is usually a comparatively 
easy task to be continent, and requires no great or extraordi- 
nary effort ; and every year of voluntary effort at chastity 
renders the task easier by force of habit. That it is an easy 
task to be continent is only true of those who have been com- 
paratively pure, in thought, word and deed. How very few of 
these exist is best known by the priest and physician. The fact 
is that even with the rarest opportunities for observation in these 
cases it is almost impossible to define any universal law or ab- 
solute rule to which every case is amenable. We must at all 
times be ready to meet, and to change our practice for, the ex- 
ceptional case, and to give advice which perhaps may be en- 
tirely opposed to the formulated maxims used in a preceding 
case. The attempt to make any rule entirely absolute is an ab- 
surdity which in our practice too many of us commit." 

Lallemand, speaking of continence, says : " There is a con- 
stant state of orgasm and erotic preoccupation, accompanied 
with agitation, disquiet, and malaise, an indefinable derange- 
ment of the functions. This state of distress is seen particu- 
larly in all young men who have arrived at puberty, and whose 
innocence has been preserved from any unfortunate initiation. 
Their disposition becomes soured, impatient and sad. They fall 
into a state of melancholy, or misanthropy, sometimes become 
disgusted with life, and are disposed to shed tears without any 
cause. They seek solitude without any cause in order to dream 
about the great mystery which absorbs them, about those great 
unknown passions which cause their blood to boil. They are 
at the same time apathetic, restless, agitated, and drowsy. Their 
head is in a state of fermentation, and nevertheless weighed 
down by a sort of habitual headache. A spontaneous emis- 
sion or escape which causes this state of plethora to cease, is a 



CONTINENCE. 1^7 

true and salutary crisis which, for the moment, re-establishes 
the equilibrium of the economy." In another chapter the same 
author continues : " The effects produced by complete pri- 
vation afford the most certain evidence of the original strength 
or debility of the genital organs. If they are powerful, such 
privation proves a kind of torture which may induce the most 
serious abuses or disorders in all the functions ; if irritable, pro- 
longed abstinence causes abundant and frequent nocturnal pol- 
lutions ; if weak, and little developed, such privation is not 
painful ; the pollutions are rare and in small quantity at first, 
but still they produce serious effect, and after a time they be- 
come more and more severe and difficult of cure. 

" These signs of energy, irritability, or weakness in the genital 
organs, are more certain than those drawn from their external 
appearance. 

" The patients of whom I am about to speak are all remark- 
able for the facility with which they support privation from 
sexual intercourse. 

" Their lives are exemplary in all respects ; not only have they 
never committed excesses or practiced abuse^ but for the most 
part they have never had any relations with the opposite sex. 
In these cases the temptation is " so slight " that to conquer it 
is not any great merit. Such constant and easy continence 
is an unfavorable sign when considered in reference to 
the powers of the genital organs ; and we should much de- 
ceive ourselves if we adopted, without examination, the ex- 
planation the patients give of their conduct. They generally 
attribute their continence to strict morality, to religious princi- 
ples inculcated in early infancy, or to the effects of good ex- 
ample ; they omit altogether to mention the little desire they 
have had to combat. But when such patients wish to break 



iBS CONTINENCE. 

their long and easy continence they find themselves completely 
unable ; not on one occasion only, but habitually ; not under 
unfavorable circumstances, but during many years of marriage. 
Such a state of things during the period of the greatest virility 
completely explains the ease with which they maintained their 
former long continence. Most of these patients, too, feel a 
strange presentiment of the catastrophe which awaits them. 
They have a suspicion of their weakness, and hence they mani- 
fest an instinctive repugnance to marriage, and hesitate long 
before they make up their minds to enter that state. 

*'A great facility, then, of supporting absolute continence ought 
to lead us to suspect want of power in the genital organs as well 
as diurnal pollutions when nocturnal ones do not occur, because 
the continued presence of semen will stimulate the least power- 
ful organs into occasional actiono 

" Let us now see what are the effects of such long continence, 
especially in these weak individualSo If fatigue be hurt- 
ful to all organs, so moderate exercise is necessary to them 
as soon as they are in a condition to act. The generative 
organs are not beyond the influence of this general law. All 
surgeons admit that prolonged inaction produces the same effects 
on the genital organs as on any other ; that is to say, that it 
diminishes their activity. The inactivity of these organs in 
children and eunuchs arises from the non-secretion of semen ; 
no pollutions can therefore arise in such cases, and the health 
does not become disordered. On the contrary, in the un- 
mutilated adult want of power can only be attributed to very 
serious diurnal pollutions, often very difficult of cure. As 
soon as the evolution of the genitals commences, the testicles 
begin to act; if their structure be not accidentally injured, they 
continue to secrete until a very advanced age. This secretion, 



COI^TINENCE. I§9 

it is true, may be diminished by the absence of all excitement, 
direct or indirect, or by momentary weakening of the system, 
or by the special action of certain medicines ; but it never 
ceases entirely from the age of puberty to the commencement of 
old age. Hence results an evident deduction, viz. : that in the 
absence of all voluntary evacuation the seminal vesicles must 
become filled more or less rapidly, and after a time must be- 
come distended ; so that if the secretion be not evacuated in 
quantity in an open and sudden manner, it must escape by de- 
grees at periods more or less close and under circumstances 
which render this evacuation difficult to be ascertained ; in 
other words, if nocturnal pollutions do not occasionally occur 
it is because diurnal ones exist. 

" From the numerous cases I have related, it is evident how 
slow and insidious the progress of this disease may be, and it 
is remarkable that those who have fallen into the most deplor- 
able condition, and whose cure has been most difficult, have 
been precisely such as had supported the disease longest with- 
out suffering much. In studying the cases attentively it be- 
comes evident that the disease commences by nocturnal pollu- 
tions, accompanied by lascivious dreams, energetic erections, 
and a lively sense of pleasure. But this orgasm diminishes by 
degrees, and the emissions at last take place without erection 
or sensation ; such nocturnal pollutions become more rare and 
sometimes cease entirely, and then the health of the patients 
becomes seriously and rapidly affected, much to their astonish- 
ment, as they have no suspicion that diurnal pollutions have 
been added to the nocturnal ones, and at last have entirely 
taken their place. By reflecting on the succession of the 
phenomena in individuals who have done nothing to aggra- 
vate their condition, and taking into consideration the salutary 



tpb CONTINENCE. 

effects which sexual intercourse produced in many of the cases 
that have come under my notice, it is impossible not to admit 
that prolonged inaction of the genital organs diminishes the 
tonic resistance of the ejaculatory ducts, disorders their sensi- 
bility, and perverts their functions, without being able to pre- 
vent the formation of semen by the testicles, or its passage 
into the seminal vesicles. Absolute continence, therefore, ren- 
ders the expulsion of semen more and more easy in these cases 
without diminishing its secretion in an equal proportion." 

There is some truth in the above description, but, I think 
with Acton that it is exaggerated. He says (and his opinion 
only repeats the opinion of all who have had much to do with 
the cases) : " It is a matter of every day experience to hear 
patients complaining that a state of continence after a certain 
time produces a most irritable condition of the nervous system, 
so that the individual is unable to settle his mind to anything ; 
study becomes impossible, the student cannot sit still, sedentary 
occupations are unbearable, and sexual ideas intrude perpetu- 
ally on the patient's thoughts. When I listen to this complaint 
I have little doubt of the confession that is to follow ; a confes- 
sion that at once explains the symptoms. Of course in such 
cases I am prepared to learn that the self-prescribed remedy 
has been most effective, that sexual intercourse has enabled the 
student to at once recommence his labors, the poet his verses, 
and the faded imagination of the painter to resume its fervor 
and brilliancy ; while the writer, who for days has not been 
able to construct two phrases that he considered readable, has 
found himself, after relief of the seminal vesicles, in a con- 
dition to dictate his best performances. In the individuals con- 
stituted as these are, continence is sure to induce this state of 
irritability. Still no such symptoms, however feelingly described. 



CONti^TENCfe. t^t 

should ever induce a medical man to even seem to sanction his 
patient's continuing the fatal remedy, which is only perpetuat- 
ing the disease. In all solemn earnestness I protest against a 
medical man countenancing such a remedy. It is better for 
such a youth to live a continent life. The strictly continent 
suffer little or none of this irritability ; but the incontinent, 
as soon as seminal plethora occurs, are sure to be troubled in 
one or other of the modes above spoken of, while the remedy 
of indulgence, if effective, requires repetition as often as the 
inconvenience returns. If, instead of gratifying his inclination 
the young patient should consult a conscientious medical man, 
he would probably be told and the result would soon prove the 
correctness of the advice given, that low diet, partial abstinence 
from meat and stimulants, aperient medicine if necessary, 
gymnastic exercises, and self control will most effectively re- 
lieve the symptoms. The truth is that most people, and es- 
pecially the young, are often only too glad to indulge to find 
an excuse for indulging their animal propensities, instead of 
endeavoring to regulate or control them. I have not a doubt 
that this sexual suffering is often much exaggerated, if not in- 
vented, for this purpose." 

Van Buren & Keyes on this point also agree that the nervous 
hypochondria, with despondency, " the excited and suspicious 
tendencies so marked and remarkable in nearly all men at any 
time of life in connection with functional or organic trouble in 
the genito-urinary tracts, are only explicable by recognizing 
that nature has implanted in man a sexual want which controls 
many actions of his life, impels him to continue his species, 
and cries out in distress whenever it is trifled with, ungratified, 
or: over-stimulated, or whenever its existence seems to be 
menacedo A man will feel more depressed at seeing a little 



■HI 



102 CdNtliSTENCE. 

excess of phosphate in his urine which he thinks, in spite of all 
proof to the contrary, indicates a " local weakness," than he 
will at loss of memory or mental incapacity, w^hich he can 
recognize himself and be fully conscious of. There are few 
men who would not rather lose a leg or an eye, than a testicle ; 
while functional or organic disease of the bladder, testicles, or 
penis, cause more mental inquietude and distress to its pos- 
sessor than does a cavity in a lung. Why should this be, 
except that nature has endowed man with an instinct of terror 
at the idea of losing his sexual capacity, and has established a 
law for the regular and judicious performance of the sexual 
^ct, which he must obey or else suffer in some way the penalty ? 
This suffering may not be evinced by symptoms in the organs 
of generation themselves, and probably will not be unless 
through excitement of those organs by abuse or irregular use, 
or unless through their stimulation by erotic fancies, the patient 
attract the morbid nervous tendency to a local explosion. A 
man perfectly pure in thought and deed would not suffer from 
vesical neuralgia, unless, of course, some physical lesion of the 
parts should first occur to excite local congestion. Old maids and 
priests suffer from sexual distress as much as young and old 
bachelors and widov»^ers, but they very rarely give any local signs 
of trouble. Their symptoms may be scattered over all the 
organs, and may impair any or all of the functions." 

In consideration of subjects of this kind, a medical man 
must look at facts as they really are, without bias or pre- 
conception, not as he thinks they ought to be, and while on the 
main points I believe as Acton does, there are unfortunate 
cases, where it is impossible to regulate the matter by simply 
giving advice. We must ascertain first, if the advice can be 
followed, and if experience teaches that it will not be followed, 



CONtiNENCE. 2$3 

then it is our duty to regulate and diminish the amount of 
immorality indulged in. Many men are by nature polygamous, 
they will indulge in the gratification of their passions, regard- 
less of consequences ; when this is the case then proper means 
should be taken for their guidance, in order that they may not 
rush into excess, or abuse themselves in a way detrimental to 
their physical welfare. It is not advisable to say to the unfor- 
unate possessor of these feelings " you must not indulge at all no 
matter what the consequences may be," but it is possible to keep 
the patient controlled by a healthy sexual relation, in the mar- 
ried state if possible. If that condition cannot be attained, 
then it is the physician's unpleasant duty to accept the fact and 
to regulate his illicit intercourse, which he certainly will indulge 
in, no matter at what risk or consequence. 

If a robust, full blooded man, with a fully developed venereal 
sense, becomes continent, nocturnal and perhaps diurnal pollu- 
tions will precede the impotence. Erotic impulses, sometimes 
amounting almost to satyriasis, may also occur before the 
virile power is extinguished. The spermatorrhoea is occasioned 
because the secretion of the testicles, prostate and other 
glands is manufactured rapidly, and has no natural cause for 
expulsion. 

The loss of virility may or may not be followed by dimin- 
ished secretion, and there are cases where the ejaculations of 
seminal fluid will not occur oftener than once or twice a year. 
Such cases are exceedingly hard to manage. 

When a man of small animalism is continent for a number 
of years, what little desire he may have formerly possessed is 
likely to disappear completely, and the emissions will be 
infrequent in both classes of patients, with or without sperma- 
torrhoea, the genital apparatus will ultimately show the relaxation 
13 



194 CONtiNENCfi. 

and other changes that occur as the result of masturbation. In 
a few instances there is atrophy of the testicles, but it is most 
unusual in persons under forty-five. 

In this connection the following cases will be of interest, as 
showing some of the varied results of continence : In the 
winter of 1876, an undertaker of this city was admitted to St. 
Francis Hospital, suffering from prolapse of the rectum. He 
was forty-five years old, and his general health was good. After 
recovering from the prolapse he informed me that he was 
impotent, and likewise was subject to nocturnal emissions. 
During the whole course of his life he had refrained from any 
gratification of his passions, and had never even attempted 
sexual intercourse, until within the past year. Twelve months 
previous to his admission, he had married a lady, thirty-eight 
years old, and without expecting anything of the kind found 
himself impotent and unable to consummate the marriage. Every 
attempt at intromission failed, through weak erections, and 
rapid emissions of semen. He denied having practiced mastur- 
bation, and the condition of his genitals seemed to confirm his 
statement. From the age of twenty-five he had emissions once 
a fortnight, and frequent erections, but the erections were 
feeble, and lasted only for a few moments. Since his marriage 
the emissions had increased in frequency, and there seemed 
to be much relaxation and apparent elongation of the penis. 
The patient did not seem to be depressed by the fact of his 
impotence. He attributed it all to total abstinence, and hoped 
that, in the course of time, nature would effect a cure. 

I am aware that there are a few cases recorded by Lallemand 
and others where diseases of the rectum were a cause of 
temporary impotence, but the patients were not continent, and 
they recovered from the spermatorrhoea and impotence when 



CONTINENCE. I95 

the prolapse was cured. In the patient whose history I 
have just given, the prolapse of the rectum may have just 
added to his genital weakness, but I am satisfied that it was 
not the cause of it. 

A second interesting case of impotence from continence, un- 
accompanied by spermatorrhoea, came under my care during 
the winter of 1881. The patient was thirty-eight years old, and 
a broker by occupation. His general health was excellent, and 
he was constantly and actively employed in a flourishing busi- 
ness. He stated that he commenced to masturbate a little when 
a boy of twelve, and occasionally was guilty of the habit until 
he reached the age of sixteen, at which time he discontinued it 
altogether. At twenty he had intercourse in a natural way, and 
without any difficulty whatever. For six months subsequently, 
he cohabited at intervals of two weeks, and never at any time 
indulged to excess. A period of eight years then elapsed with- 
out any opportunity for sexual congress. At the termination 
of that period he again attempted to renew his sexual relations 
with his former partner, but to his great annoyance failed. 
Though he subsequently made frequent trials, the result was 
the same. He finally gave up all hope, firmly believing that his 
impotence was beyond the reach of therapeutical agents. He 
attributed his loss of virility to continence, and not to any dissi- 
pation or bad habits in early life. A period of ten years elapsed, 
during which interval he tried sexual congress but once, and 
was unsuccessful. He had a few emissions, and few erections, 
and for twelve months previous to calling at my office, he had 
had only three emissions, and no erections of any degree of per- 
manency. He thought his desire for sexual pleasures had not 
diminished, but the knowledge of his impotence being ever 
present, would prevent him from attempting it again. Thi? 



IBMi 



196 CONTINENCE. 

mental state necessarily complicated his case, and added 
to the difficulty of a cure. On making an examination of his 
genital organs, I found the penis and testicles somewhat smaller 
than natural. The left testicle was smaller than the right, and 
more than ordinarily sensitive to pressure. Otherwise the parts 
were unchanged. Knowing that the patient's habits were ex- 
cellent, and that his general health was good, I made a favor- 
able prognosis, and put him under treatment. He continued 
under treatment for three months, improving slowly. His erec- 
tions were more frequent and natural, and his hopes of final 
recovery revived. He suddenly, without any notification, ceased 
his visits at the office, and I saw nothing more of him until the 
summer following, when he came in as I was about leaving for 
the country, and with a broad smile on his face said, " Doctor, 
I have the clap." He then went on to inform me that a few 
days after he had ceased calling, he renewed his attempt at in- 
tercourse, and had succeeded, and had kept well in that respect 
ever since. His gonorrhoea was the result of leaving his mis- 
tress, and assuming relations with a less reliable woman. These 
two cases are very good examples of the varieties of impotence 
by continence, viz : that which is characterized by activity of the 
secreting organs, and resulting in spermatorrhoea, and that which 
is accompanied by loss of erection and diminished secretion. 
Now, the most difficult problem to solve, as already stated, is 
the best line to follow in the way of treatment. Of course, if 
the spermatorrhoea and impotence and great nervousness and 
mental distress which usually attend such cases is the result of 
continence, then one of the principal things to advise is sexual 
intercourse, whenever the patient's physical weakness is re- 
moved and the organs able to fulfill their function. Here the 
physician is brought face to face with the great moral law, which 



CONTINENCE. I97 

is supposed to govern, but which really does not govern civilized 
Christians. Marriage is in many cases impossible, from lack of 
means, or inclination, or the presence of an acceptable woman 
willing to enter into the partnership. It is a difficult matter to 
determine, while we all acknowledge that a pure life is the best 
under all circumstances. Here is a man who cannot be cured 
by legitimate moral means, but can be relieved by 
breaking a moral law. Acton seems to have been troubled by 
the same vexatious problem. He says : " It was far from my in- 
tention when I commenced this work to put myself forward 
as a religious teacher, but I so frequently receive letters from 
young men, seeking advice how to cure the lusts of the flesh, 
that I was induced to inquire as to the views entertained upon 
the subject by the modern executive of the church of England. 
I found, on application to competent persons, that it is not 
deemed expedient to be very diffuse upon the observance of the 
Seventh Commandment. I was referred, indeed, by one worthy 
divine to the heads of " Fasts and Vigils," in our offices, but 
after careful perusal, I was unable to discover much that could 
be of assistance to the earnest layman desirous of arming liim- 
self against the promptings of nature and imagination. All the 
help that one excellent clergyman can give to tempted clergy- 
men brethren, is this : "Another man is tempted by evil 
thoughts at night. Let him be directed to cross his arm upon 
his breast, and extend himself as if he were lying in his coffin. 
Let him endeavor to think of himself as he will be one day 
stretched in death. If such solemn thoughts do not drive 
away evil imaginings, let him r;se from his bed and lie on the 
floor." 

Going further into the religious aspect of the case, he says : 
" The Church of Rome, with that practical wisdom which so 



■!^ 



198 CONTINENCE. 

often characterizes her, and which no Protestant prejudices 
should lead us to deny, has in many of her arrangements and 
in much of her authorized teaching, fully and sympathizingly 
recognized the great facts of the existence and intensity of 
sexual misery and temptation, and of the absolute necessity of 
sexual purity, for those who would reap the blessings of conti- 
nence." 

The following extracts from the instructions on the com- 
mandments and sacraments, by St. Alphonsus M. Liguori, 
are teachings referred to above : " In every sin of thought 
there are three things, the suggestion, the delectation, and the 
consent. The suggestion is the first thought of doing an evil 
action which is presented to the mind. This is no sin; on the 
contrary, when the will rejects, we merit the reward. Even 
the saints have been troubled by bad thoughts. To conquer a 
temptation against chastity, St. Benedict threw himself amongst 
thorns, St. Peter of Alcantara cast himself into a frozen pool. 
Even St. Paul writes that he was tempted against purity. 
After the suggestion comes the delectation, when if the person 
is not careful to banish the temptation immediately, but stops 
to reason with it, the thought instantly begins to delight, and 
thus continues to gain consent of the will. As long as the 
will withholds the consent, the sin is only venial, and not 
mortal. But if the soul does not return to God, and make an 
effort to resist the delectation, the consent will be easily 
obtained. The soul loses the grace of God, and is con- 
demned to hell, the instant a person consents to the de- 
sire of committing sin, or delights to think of the immodest 
action as if he were committing it. This is called morose 
delectation, which is different from the sin of desire. He who 
contract? the h^bit of consenting to bad thoughts, exposes 



CONTINENCE. I99 

himself to great danger of dying in sin — first because it is very- 
easy to commit sins of thought. In a quarter of an hour a 
person may entertain a thousand bad thoughts. My brother, 
do not say, as men do, that the sins against chastity are light 
sins, and that God has compassion on such sins. What I do 
say is that ' No fornicator hath inheritance in the kingdom of 
Jesus Christ, and of God.' (Eph. v, 5.) Even the pagans held 
impurity to be the worst of vices, on account of the bad effects 
which it produces. Seneca says : * Impurity is the foremost of 
the world's wickedness,* and Cicero writes : * There is no more 
heinous pest than the indulgence of uncleanliness.* St. Isodore 
has written : * Whatsoever sin you name you shall find nothing 
equal to this crime.' For those who are unable to abstain from 
impurity, or who are in great danger of falling into it, God has, 
as St. Paul says, instituted matrimony as a remedy. * But if they 
do not contain themselves, let them marry, for it is better to 
marry than to be burnt.' (I. Cor. vii, 9.) But, some may say, 
father, marriage is a great burden. Who denies it ? But have 
you heard the words of the apostle : It is better to marry, and 
to bear this great burden than to burn forever in hell. But do 
not imagine that, for those who are unwilling or unable to 
marry, there is no other means but marriage by which they 
preserve chastity. By the grace of God, and by commending 
themselves to him, they can conquer all the temptations of hell." 
" The fifth remedy, which is the most necessary for avoiding 
sins against chastity, is to fly from sins against chastity, fly 
from dangerous occasions. Generally speaking, the first of all 
the means of preserving yourself chaste, is to avoid the occa- 
sion of sin. According to St. Bernardine, it is a greater miracle 
not to fall into the occasion of sin than to resuscitate the dead. 
It is necessary to abstain from reading bad books, and not only 



200 CONTINENCE. 

those that are positively obscene, but also of those that treat 
of profane love. O, fathers ! be careful not to allow your 
children to read romances. These sometimes do more harm 
than even obscene books ; they infuse into young persons cer- 
tain malignant affections which destroy devotion, and after- 
wards impel them to give themselves up to sin. And here I 
repeat, do not allow your daughters to be taught letters by a 
man, though he be a St. Paul or a St. Francis of Assisium." 

So much for the religious aspect of the case. There can be 
little doubt of the correctness of the advice given, but it does 
not answer the original question. I presume that it is the duty of 
the conscientious physician to say to the patients suffering 
from continence, or the result of continence, that marriage is 
the only remedy — not promiscuous intercourse — and leave the 
rest to the patients. My experience is that they have acted as 
they pleased so soon as they learned that intercourse was one 
of the essentials to perfect health — while a few get married, the 
large majority indulge their natural instincts without the for- 
mality of marriage, and dispense with further advice on the 
matter. Besides spermatorrhoea and impotence, prolonged 
continence may give rise to affections of the prostate and 
bladder. It is at times a cause of the worst forms of satyriasis, 
and pathophobia. These affections are considered in another 
chapter. 

Prolonged continence sometimes developes in females all 
the series of nervous manifestations classed under the head of 
hysteria. It is also a common cause of nymphomania, (see 
Chapter VIII.) and of ovarian neuralgia. 

Women do not suffer so much as men do from continence. 
Indeed the majority of healthy women are not much injured by 
total abstinence after the age of thirty, and to very many 



CONTINENCE. 20I 

sexual intercourse is a source of pain and mortification instead 
of pleasure. They are not compelled to suffer as men are 
from the distension of a highly organized set of organs, with a 
constant secretion, which creates in most men an irritation 
that certainly injures unless relieved by nocturnal emission or 
intercourse. The congestion accompanying the menses creates 
only a temporary excitement and desire, which is relieved at 
once by the flow of blood. 

The treatment of these cases will be considered in connec- 
tion with the treatment of spermatorrhoea and impotence. 



CHAPTER XI. 

CLASSIFICATION OF CASES FOR TREATMENT, 

Universal Rules which should not be Universal — The Danger of Advising a 
Single Method of Treatment for all Cases of Spermatorrhoea and Impo- 
tence without a Special Study of Each Case — Errors in Treatment — Bro- 
mide of Potassium as a Remedial Agent — Its Effects on the Vascular and 
Nervous Systems — How it Affects the Digestive Function — Injurious 
Effects Arising from the Indiscriminate Use of the Drug — Bromide of 
Potassium as a Cause of Impotence — Cauterization of the Prostatic 
Portion of the Urethra — Its Universal Use in the Treatment of Sperma- 
torrhoea — Why a Division of Cases is Necessary — Four Varieties of Sper- 
matorrhoea and Impotence — Peculiarities Exhibited by Cases of the 1st 
Class — Cases which are Incurable — Second Variety— Distinguishing 
Features — Patients Amenable to Treatment — Peculiarities of Third and 
Fourth Class of Cases — Greater Frequency of the Milder Forms of Sper- 
matorrhoea and Impotence. 

There is a growing tendency in the modern mind to " make 
laws as well as to break them." In every department of medi- 
cine stringent rules are formulated to guide all persons irre- 
spective of age, sex, hereditary tendencies, idiosyncrasies, occu- 
pations, sympathies or surroundings. The pathology of a 
disease is scientifically described. Each symptom pointed out. 
But just there the discrimination is apt to terminate. A stereo- 
typed set of remedial agents is recommended for every patient 
suffering from the disease spoken of. No iraportance seems to 
be attached to the fact, that " wnatis one man's me^t is another 
man's poison." It is a general though a fallacious idea that an 
agent which is beneficial in one case, must necessarily be of 
utility in every other case of the same nature. It is this which 
occasions the cry of humbug in medicine. The young prac- 



CLASSIFICATION OF CASES FOR TREATMENT. 20^ 

titioner with his first case, follows the prescribed rules — gives 
his patient the orthodox medicine, and is unsuccessful. His 
faith is shaken in the authority once revered, and he turns in 
another direction for a more reliable guide. His second case 
may, in its results, be a mere repetition of the first, unless that 
failure has taught him to examine for himself the phenomenal 
symptoms or characteristics which belong to the individual under 
treatment. The fault is not in the medicine prescribed, in its 
quantity or quality. The mistake lies wholly in the neglect of 
a systematic classification of different forms of the same disease, 
founded, to some extent, on the peculiar developments and 
idiosyncrasies of the patient. There are so many remarkable 
differences in the habits, occupations, and vitality of people, 
that the treatment successful in one instance may be absolutely 
injurious in another. Each case demands special study. Each 
peculiar tendency and sympathy should be contrasted and 
studied. Occupations and their varied results on the economy 
should be examined. Previous effects of treatment are always 
to be considered. Medicines which before failed, or which 
have produced unpleasant effects on the economy, or for which 
the patient had a disgust, should never again be repeated. 

Such a classification is particularly necessary in cases of 
spermatorrhoea and impotence and the special study of each case 
before treatment is commenced is an imperative necessity. 
Usually in these cases little or no differentiation is attempted. 
Any one who takes the trouble to peruse the various text-books 
and monographs on the subject, will find an arbitrary system of 
medication adopted. For instance bromide of potassium is 
recommended to the majority of patients suffering from 
seminal emissions. Its use is general. But I think the experi- 
ence of those who have looked beyond the temporary and per- 



204 <^MSS1F1CAT10N OP CASES FOR TREATMENT. 

haps only apparent beneficial effects of the drug, will agree with 
mine. I have no hesitation in saying that its administration in 
spermatorrhoea and impotence is a source of incalculable injury 
to the patient. To understand this statement more thoroughly, 
let us for a moment examine the local and constitutional effects 
of the drug. 

When given in full medicinal doses for two or three weeks it 
has a depressing effect on the nerve centers. This is evidenced 
by the defective memory, dullness of sight and hearing, ten- 
dency to sleep and weight and fullness about the head. It is 
known to diminish the supply of blood to the brain and cord and 
thus aggravate the symptoms mentioned. It is known to im- 
poverish the blood and prevent assimilation. Few persons can 
use bromide of potassium for any great length of time without 
suffering from nausea, and other signs of defective digestion. 
It impairs, and may altogether destroy, the virility of the patient. 
Hensle says it produces insensibility of the fauces and torpidity 
of the genital organs. Many other authorities agree with him. 

Bartholow says with reference to the action of the bromides : 
" A very notable action of the bromides — chiefly bromide of 
potassium — is the diminution of the sexual feeling and of the 
power of the erections produced by it. This fact has been es- 
tablished by abundant clinical evidence The pallor 

and anaemia of bromism are due to several causes: to the dimin- 
ished action of the heart, slowness of the capillary circulation, 
a consequent interference in the metamorphosis of tissue, de- 
rangement of digestion and assimilation in consequence of gas- 
tric catarrh, and diminished blood supply to the cerebro-spinal 
axis, the disorders of voluntary movement, the uncertain gait, 
the apparent defects of co-ordination, are variously explained, 
but they are doubtless made up of several factors of which 



CLASSiFiCATiON OF CASES FOR TREATMENT. 20^ 

cutaneous anaesthesia is the most influential. The bromides 
possess the power to destroy or impair the irritability of the 
motor and sensory nerves, and the contractility of muscle, and 
to these effects must be attributed in part the disorders of vol- 
untary motion noted above It is very evident that 

the bromides depress certain organic functions : they diminish 
the action of the heart, lower the animal temperature, and lessen 
the blood supply to various organs. These results can only be 
accomplished by a sedative influence on the sympathetic nervous 
system. Some observers have maintained that in this action 
lies all the physiological power of the bromides." 

Little argument is needed to show that the administration of 
a medicine which in nearly all persons produces the effects men- 
tioned must necessarily be injurious to patients suffering from 
the effects of masturbation or sexual excesses. A patient whose 
nervous system is already anaemic from bad habits and frequent 
seminal losses certainly does not need a medicine which still more 
diminishes the quantity of blood going to his brain and spinal 
cord. When the digestive function is disturbed and the powers 
of nutrition enfeebled, it is worse than useless to prescribe a drug 
which causes nausea and vomiting and prevents absorption. 
If the genital organs are weakened and virile power unequal 
to the demands upon it, it will not conduce to the benefit of 
the patient to administer a medicine which has the power of 
destroying erections. The nerve power, the vitality of all per- 
sons suffering from spermatorrhoea is much below the normal 
standard. The bromides by diminishing this force can do no 
possible good unless indeed on the principle of similia similibus 
curantur. The reason for the indiscriminate and careless use of 
this drug is simply because it has the power of diminishing the 
sensibility of the mucous lining of the urethra, especially of that 



2o6 CLASSIFICATION OF CASES FOR TREATMENT. 

portion contained in the prostate gland. In this way it dimin- 
ishes for a time the number of seminal losses. This temporary 
improvement in the eyes of the ignorant patient is a positive 
sign of a permanent curative action. And for the sake solely 
of this apparent benefit much evil is done and a disturbed 
and diseased system brought still lower in the scale. 

There are only a very few cases where the administration of 
the bromides is admissible, and these will be pointed out in 
another chapter. 

The tendency to pursue a stereotyped course of treatment is 
also witnessed in the local management of spermatorrhoea. 
Many years ago Lallemand recommended caustic applications 
to the prostatic portion of the urethra to diminish the irritabil- 
ity of the orifices of the ducts which open in this portion of the 
canal. Since his time caustic applications, both in liquid and 
solid form, are unusually recommended as the principal local 
remedies. In the cure of the affection, there can be no doubt 
that the use of caustic in certain cases is followed by benefi- 
cial results, and I have myself used them with great benefit. 
But the majority of patients only receive a temporary relief, 
which is dearly paid for by the intense suffering from caustic 
application which invariably ensues. And the discharge of 
blood and purulent exudation, independently of the pain, 
add very much to the mental depression of the patient. 

CLASSIFICATION OF CASES. 

A systematic division of all cases of spermatorrhoea can 
always be made. Each class affords some special indication 
for treatment which, if employed in another class, would be 
exceedingly injurious. Not only is this distinction between 
each class a necessity, but each special case must be studied 



CLASSIFICATION Ot* CASES FOR tREATMENt. 207 

thoroughly by itself, without respect to any other case of the 
same class. Each patient usually presents some peculiarity 
which requires the physician to vary his treatment in one or two 
important particulars upon which the permanent relief of the 
patient may depend. 

The various cases of spermatorrhoea may be divided into 
four different classes. Though each class will be found to 
have many symptoms in common, yet there are variations so 
marked that there will be little difficulty in placing each patient 
in his proper class for treatment. When this division is made 
and the characters peculiar to each described, it will be well to 
give the various local and constitutional measures which have 
been found useful in all — therapeutical agents which are indi- 
cated in all, and then point out the special indications which 
belong to each particular class. 

In the first class the mental derangement is greater than the 
physical. The mental status approximates more nearly to that 
of the lower animals than in any other affection short of com- 
plete insanity. These cases are happily of rare occurrence. 

Patients of this class are found usually between the ages of 
sixteen and twenty-five. The habit of masturbation commenced 
in early childhood and was indulged in to excess for many years. 
The patient does not seek medical advice himself. His parents 
or friends generally compel him to submit to treatment. He 
has been warned and instructed carefully as to the evils which 
surely accompany a persistence in the vile habit. The best 
directed efforts to show him that the path he is following will 
eventually terminate in complete destruction of mind and 
body, give negative results. And though he is fully aware of 
his debased, hardened condition he persists in self-pol- 
lution. 



2oS CLASSIFICATION OF CASES FOR TREATMENT. 

He accomplishes the act at every opportunity. Alone and in 
company of friends or strangers he gives rein to his propensi- 
ties. Every vestige of moral sense seems to have disappeared 
and he cares only for the sensual gratification which mastur- 
bation produces. 

This class of patients may or may not be emaciated. I have 
seen two cases where there was very little loss of flesh. The 
face has usually a yellowish pallor, and is often covered with 
pimples. The eyes are restless and wander from one object 
to another, studiously avoiding the gaze of the examiner. The 
head hangs down and rests on the chest. He is restless and 
unable to remain long in one position. He '* slouches" around 
from one corner to another, dragging his feet slowly along 
after him as if they were too heavy for his body. When the 
countenance is at rest he has all the appearance of an imbecile. 
The hands are placed between the thighs, or are held in the 
pockets of the pantaloons in close proximity to the genital or- 
gans. The answers which he gives may have no special bear- 
ing on the subject under examination. He prefers to answer 
in monosyllables. "Yes" and "No" are all that can be 
obtained from him in the way of information. He 
cannot or will not pronounce a sentence of any length. 
To get more of his history some harshness is necessary. 
In fact his mentality is so much below par — so sluggish in 
its action, that only by great labor can he speak connectively. 
He may be seen even while undergoing the physician's exami- 
nation to twist his hands about and so endeavor to bring on an 
orgasm. Sometimes his public attempts at masturbation seem 
to be done unconsciously. The mind losing sight of the fact 
that persons are around him, is occupied by the one controlling 
desire, a desire which absorbs every faculty of his being. 



CLASSIFICATION OF CASES FOR TREATMENT. 20^ 

In all such cases there is no will-power left to assist the 
efforts of the physician in promoting a cure. A favorable 
termination of the disease is almost impossible. An unfavor- 
able prognosis should always be given. If, however, the patient 
is less than eighteen when brought under observation, the treat- 
ment may not be altogether without favorable results. The 
young have great power of reaction, and if means are employed 
to keep the act of masturbation from being committed for a few 
months, and efforts made to build up the patient, a cure may 
be effected. The close and constant supervision which is 
necessary for this result, however, is rarely attainable. To show 
this, I will relate the case of a young man, a resident of New 
York, and the son of a wealthy citizen, who masturbated him- 
self into insanity, and into an early grave. His nurse taught 
him to masturbate when he was but five years of age. He fol- 
lowed the vicious instructions of his teacher until he was six- 
teen years old, at which time the whole household became 
horrified at his public attempts at self-pollution. He titillated 
his genital organs in the presence of both male and female 
members of his family. Prayers and threats were equally un- 
availing in changing the current of his thoughts or suppressing 
the habit. He was watched night and day by faithful servants, 
but he still managed to masturbate by means of bedclothes and 
peculiar twisting motions of his body and limbs. His hands 
were tied and his genitals blistered, but yet he twisted and con- 
torted until he produced emissions. Finally he was placed in 
a warm room without clothing and with little bed furniture, and 
made to lie with his hands and feet fastened. He was fed and 
washed by the servants who never left him alone for a moment. 
Under this harsh treatment he was prevented for a few weeks 
from indulging his vicious propensities. The physician then 
14 



2i6 CLASSIFICATION OF CASES FOR TREATMENT. 

thought that by placing him in a room with a prepossessing 
female, he might be led to turn his sensual devices into their 
natural channel. The questionable advice was followed, a hand- 
some nyjnph du pave was obtained and placed by his side. 
Every restraint was removed and developments awaited. It is 
hardly necessary to say that the experiment failed ; for at the 
very moment the patient's hands were freed he commenced 
masturbating with redoubled energy. He paid no attention 
whatever to the female by his side. 

A few months subsequently epilepsy and insanity supervened, 
and death finally relieved him of his malady. 

Patients of the second class are generally found between the 
ages of eighteen and twenty-five. The habit begins a short time 
before the development of puberty, and continues until years 
of discretion are reached. The patient will tell you that every 
night he has emissions which are seldom accompanied by pleas- 
urable sensations. Under the influence of strong excitement, he 
may have in the daytime emissions without erections. He is un- 
able to complete sexual congress, intromission being prevented 
by feeble erections and premature expulsion of seminal fluid. 

His mind continually dwells on his affliction, and he is un- 
able to concentrate his attention on any other subject. All the 
minutiae of the dreams are continually before him. He suffers 
from vertigo, dimness of vision, backache, headache, loss of 
appetite, constipation, palpitation of the heart and great de- 
pression of spirits. He is restless at night and troubled with 
frequent nightmares. His sleep is broken, and when he rises 
in the morning he feels unrefreshed and tired out. His condi- 
tion is made worse by exaggerating the symptoms, and continu- 
ally dwelling upon them. His countenance is indicative of 
anxiety and physical weakness. There is a haggard look about 



CLASSIFICATION OF CASES FOR TREATMENT. 211 

him which expresses the mental anguish in a striking manner. 
Sometimes patients of this class have a phthisical appearance 
without phthisis being present. If the genital organs are ex- 
amined they will be found to have decreased in size. The penis 
is bent laterally. The veins are enlarged and appear prominently 
through the integumental covering of the organ. The scrotum 
is relaxed and cold. The testicles are small and hang much 
lower than they do in a healthy state. They are soft and ten- 
der on slight pressure. A varicose condition of the sper- 
matic cord is almost always present. A sound introduced into 
the urethal canal will not give rise to any special unpleasant 
sensations until the prostatic portion is reached. At this point 
the patient will complain of intense pain, and a desire to uri- 
nate. The pain may be so severe as to make him cry out, and 
he will beg to be excused from any further examination. I 
regard this sign as indicative of excessive masturbation or of pro- 
longed or inordinate sexual indulgence. Even when patients 
deny m tne most emphatic manner that they have been guilty 
of the vice, the pain excited in the prostatic portion of the 
urethra by the sound assures me that they have spoken falsely. 
Occasionally the removal of the sound will be followed by a few 
drops of a viscid fluid, opaque in character which the patient 
calls semen. It is not semen^ but merely the secretion from 
the gland pressed out by the contraction of the muscular fibres 
as the sound is withdrawn. Following the passage of the sound 
there is a scalding sensation during and after micturition, and 
frequent desire to micturate. At the termination of the act 
more of the secretion previously mentioned appears at the 
meatus. It is also present from straining at stool, horseback 
exercise, or other acts which cause the muscular fibres around 
the neck of the bladder to contract. 



212 CLASSIFICATION OF CASES FOR TREATMENT. 

Though the health of the patient is impaired, and the will 
power weakened, there is usually enough intelligence and man- 
hood left to appreciate the situation, and sufficient firmness left 
to make him cease from onanistic exercise, and the careful 
practitioner can generally promise a positive cure if the habit 
has been abandoned and all the hygienic and medicinal mea- 
sures carried out as he has directed. 

Patients of the third class are more numerous than either 
of the preceding. Every practitioner has met with numbers of 
such cases. There is nothing alarming in their condition, yet 
their mental distress calls for the same judicious care and man- 
agement demanded by patients of the second class. Patients 
of this class commence masturbating at an early age, and con- 
tinue it at greater or lesser intervals for five or six years. At 
sixteen or seventeen they are awakened to the dangers of the 
course they are pursuing, and they discontinue the habit at once, 
or indulge in it at much longer intervals of time, as little harm 
harm results. Two or three months subsequent to the cessation 
of the habit, involuntary seminal losses commence. At first 
they occur perhaps once in a week, but as the patient grows older 
and the sexual organs become the seat of increased excitement 
from associations with women, the emissions increase in 
number, while at the age of twenty, or thereabout, they occur 
three or four times each week ; or, as is sometimes the case, 
two or even three emissions may occur in a single night, and 
then not again for seven or eight days, when the double emis- 
sions again appear. He is sometimes able to have sexual inter- 
course, but the intercourse is rarely satisfactory from sudden 
ejaculation. The involuntary emissions cease while the passions 
are indulged in a natural manner, but they re-appear when 
the intercourse has ceased. The patient soon becomes very 



CLASSIFICATION OF CASES FOR TREATMENT. 213 

nervous about his health. Every trouble is magnified. Every 
little nervous sensation about the genitals is magnified into some- 
thing fatal to his virility. His desires are stronger than ever, 
he is easily excited by the presence of a pretty woman, and he 
can scarcely help showing the lust of his mind. ■ The genital 
organs are' relaxed, but the penis and testicles are of a normal 
size. The passage of the sound produces a little pain, not 
nearly so intense, however, as in the cases previously mentioned. 
There is nothing in the countenance of the person to show that 
he has ever indulged in any self-pollution, or was subject to 
involuntary seminal losses. In light-complexioned persons 
there may be a dark ring around the eyes, but as this is also a 
sign accompanying over-indulgence in sexual intercourse, it has 
no special significance. 

These patients are active, but they are often troubled with 
palpitation of the heart. They are also apt to be short- 
winded after exercise of an active nature. 

The mental distress is the worst symptom they exhibit, and 
the hardest to get rid of. All the evils that it is possible to be- 
fall them are constantly talked about. They read everything 
written on the subject of spermatorrhoea and impotence and 
have found in themselves every symptom of the worst cases 
mentioned. Partial, and even complete, loss of virility may 
finally ensue. 

All cases of this class can be cured in a short space of time, 
and with very little trouble. In fact many of them recover 
without any medical treatment whatever. 

Patients belonging to the fourth class are found more fre- 
quently among married than among single men. I will take the 
case first of the single man : He has not indulged to excess 
in sexual intercourse, nor has he ever masturbated. His habits 



214 CLASSIFICATION OF CASES FOR TREATMENT. 

are usually regular. He has a highly developed nervous or- 
ganization, but usually enjoys excellent health. When his gen- 
ital organs are matured and his venereal sense fully developed, 
seminal emissions occur once, or perhaps twice in a fortnight. 
He becomes intensely excited when he thinks of sexual inter- 
course, and when his desires culminate he finds that his great 
nervous excitement prevents the accomplishment of the act. 
The depression of mind that follows the first failure makes 
failure certain in the second attempt. He becomes the victim 
of mental impotence, and in a state of great depression consults 
his physician. His first visit to the physician will either help to 
fix the disease upon him for months or will secure him from any 
further anxiety. 

The married patient, like the preceding, has not been guilty 
of excesses. He has a highly developed nervous organization. 
During the occurrence of some trouble which depresses his ner- 
vous system, he fails in the performance of his sexual function. 
The first failure is the progenitor of a series of failures. He 
imagines that continence will do him good. The only result 
from this procedure is the development of seminal emissions 
which, in the course of time, may be so frequent as to under- 
mine the patient's health. 

It is only in rare instances that the physician can obtain 
from patients of this class any history of masturbation or sex- 
ual excess. Local and general examinations would give nega- 
tive results on that point. Yet their condition is very bad. 
Their mental anxiety is great ; indeed, it may be as distressing 
as in patients of the second class. The mind alone is at fault, 
and mental influence brought to bear upon them in a judicious 
manner is the essential part of the treatment. With judicious 
management they usually recover. 



CHAPTER XII. 

CONSTITUTIONAL TREATMENT OF SPERMATORRHOEA, IMPO- 
TENCE, AND ALLIED DISEASES. 

General Debility, a Leading Feature in the Majority of cases — A Special 
diet necessary for each patient — How to select a suitable diet — Cases in 
which the number of meals should be increased — Condition of the Genital 
Organs not to be considered in selecting food — Nutritious Articles not to 
be set aside because they have a tendency to excite the Genitals — Eggs, 
Oysters, Clams, Raw Beef, Broths, Gluten, Cracked Wheat, Cream, Milk, 
etc., Essential Articles — Digestible Salads — Method of preparing Raw 
Beef — Quantity of food for each meal — Incompatible mixtures of food in 
the stomach, and their effects — Rules for the selection of compatibles — 
Food that should be eaten — Food that should be excluded from the bill of 
fare — Meat not to be eaten with milk — Other Incompatibles — No lard or 
pork to be used in cooking — Mild wines permitted in the treatment. 

Nearly every case of spermatorrhoea and impotence exhibits 
marked evidence of depraved nutrition. Constitutional treat- 
ment is consequently as much of a necessity as local treatment. 
Indeed many cases may be cured by constitutional treatment 
alone, by strict attention to all the known hygienic rules, by a 
nutritious regimen, and moderate use of tonic medicines. 
When the organs which regulate absorption and assimilation 
are brought to a healthy working standard, then, and only 
then is there a prospect of a favorable issue. Therapeutical 
agents which regulate the action of the alimentary canal, skin 
and kidneys, and give tone to the system, are of much value in 
the treatment of spermatorrhoea and impotence, but they too 
can sometimes be dispensed with, if nutritious food is carefully 
and judiciously selected. A suitable diet regulated by the 



2l6 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 

wants of the patient will always do more towards accomplishing 
a cure than will the best selected medicinal agent, without such 
attention to diet. 

A few questions from the physician will soon determine the 
variety of food which will agree or disagree with the patient. 
Having obtained this important information as the first regular 
step in the course of treatment, it will be well to exclude from 
the mind any anxiety respecting the morbid condition of the 
genital organs, or the effects which the food will have on the 
secretions of these organs, or the changes it may excite in their 
working capacity. The aim should be to build up the patient 
irrespective of every other object. I am particular in impress- 
ing this point because some authorities condemn articles of food 
on account of their supposed tendency to increase seminal 
emissions. They believe in excluding everything which dis- 
plays a tendency to stimulate the secretion of the testicles or 
promote erections. Now the most nutritious elements of food 
effect this result. In fact everything that increases the vitality 
of the patient stimulates and gives tone to the genital organs. 
The stimulation is not abnormal. It is not an increase in the 
already existing irritation. It is a development of a normal 
power, a renewal of strength and functional activity, which is 
the end and aim of all methods of treatment. And it is of lit- 
tle consequence that a few additional emissions occur 
at the commencement. As the case progresses and approaches 
a favorable termination the number of emissions will be much 
diminished. No greater mistake has ever been made in the treat- 
ment of spermatorrhoea and impotence than to recommend a 
diet or a medicine which will not stimulate or give tone to the 
organs of procreation. Such depleting diet is ordered for the 
same reason that bromide of potassium is given, viz., to diminish 



CONSTITUTIONAL TREATMENT OF IMPOTENCE. 217 

the ejaculations of semen, to relieve a symptom at the expense 
of the vitality of the patient. 

Eggs, oysters, milk, cream, raw beef, chicken, strong broths, 
thickened with barley, cracked wheat, oat meal, etc., should 
be ordered to be taken frequently and in such quantities as 
will suit the digestive force of the patient. One person can 
assimilate a much larger quantity of food than another, and it 
is safe to assume that whenever uncomfortable sensations are 
excited in the stomach by a meal that either the quantity of 
food is too great or that it is not the kind of food which is 
suitable for the patient. In cases where the vitality is much 
impaired, as in the first two classes mentioned in the previous 
chapter, it will not do to confine the patient to the ordinary 
system of three meals each day. The stomach will not prepare 
such an amount for absorption, and much of the food taken 
will pass out undigested or unchanged. Instead of three large 
meals in twenty-four hours, the patient should have six or 
seven small ones. Dividing the eating hours in this way the 
stomach will be enabled to take up far more of the nutritive 
elements of the food than in any other way. 

For several years I have pursued about the same plan of 
treatment in these cases as I do in phthisis, giving only that 
variety of food which can best be assimilated. There are 
many different articles of diet taken into the stomach which 
are entirely incompatible, and which, by the peculiar changes 
produced in each other by the digestive reagents, and their own 
peculiar ingredients, retard, rather than assist, digestion and 
assimilation. With a little care, both the quality and quantity 
of food best suited to the peculiar needs of the patient are 
easily ascertained, and the patient is then put in the best possi- 
ble condition to begin his fight for restoration to health. L^t 



2l8 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 

US see first what kind of food should not be eaten, and what 
ingredients employed in cooking should be left out. 

Neither lard nor pork should be used in cooking. Fresh 
beef suet, or melted butter, should be employed instead. Of 
the two, the beef suet is preferable to the butter. Smoked food 
of all kinds is injurious. Fresh bread, pastries, hot puddings, 
are also to be left from the bill of fare. Fried oysters should 
be avoided. Any fried food is objectionable. Salt fish and 
meats, pickles, olives, cheese, and bananas should not be eaten. 
Milk and flesh food should never be taken at the same time. 
Two hours should elapse after a meal where meat of any kind 
is served, before milk is taken. When fresh meat is served, 
butter on bread or otherwise is prohibited. No oily substance 
of any kind should be employed in cooking a steak, or in mak- 
ing a gravy for it. It should be broiled only. All soups should 
be cooked the day before they are used, and all the fat skimmed 
off before serving. All fruit eaten should be cooked, with the 
exception of oranges and grapes. 

Mustard may be used ad libitum with all kinds of meats. 

Salads may be eaten at any meal. Among the salads which, 
curiously enough, agree with delicate stomachs, is a salad made 
from the inner leaves of red cabbage, dressed with oil, salt, 
pepper, and vinegar if desired. The oil must be absolutely 
pure olive oil, and should be put on the leaves first. Ordinary 
field lettuce, carefully dressed, is also a desirable article of 
diet. Potato salad may be eaten with lunch. If the onions 
in it are objectionable they may be left out, and celery salt 
substituted. Another salad that suits some may be made of 
good Florida oranges. Take good oranges, peel and slice and 
free from seeds. Add oil and salt and a quantity of cayenne 
pepper. 



dONStltUtlONAL TREATMENT Of IMPOTENCE. :^I9 

The best bread to use is Graham bread, and it should be at 
least one day old before being eaten. Pumpernikle bread is 
also good for a change. 

Jellies contain very little that is nourishing, and as a rule 
should not be used. There is one exception, however, to this 
rule, and that is cranberry jelly ; this is both nutritious and 
palatable, and assists the digestive process. 

Boiled cereals of all varieties may be eaten cold or warm, 
with sweet cream, or syrups that are made of melted cane, or 
maple sugar. 

Beef and mutton are preferable to lamb or veal — the latter 
may be left out of the bill of fare. 

Fresh fish of all varieties eaten with rice or other boiled 
cereals, can be generally easily digested by the most delicate 
stomach. 

As a sample of the method by which some ordinary forms of 
solid food may be prepared so as to suit the digestive apparatus 
of a person much debilitated by excess or disease, I give the 
following : If mutton or lamb chops or chicken is desirable, 
the chops or the chicken should be put in the pan, with just 
enough water to cover them. Cook thoroughly, in the meantime 
sprinkle a little salt and pepper. Take out the chops, and add 
to the liquid, butter, and a little flour, and curry powder. Boil 
some rice in salted water, and add to this the gravy in the dish. 
Chops cooked in this manner form a most savory, palatable, 
and digestible dish. 

I am accustomed to order the first meal to be taken in the 
morning as early as half-past six or seven o'clock, even if the 
patient does not rise to eat it, but takes it in bed. I do this 
because the second sleep in the early morning, if allowed to 
run on to eight or nine without disturbance, is liable to make a 



226 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 

marked difference in the feeling of congestion which most of 
these patients experience about their genitals, at that time, 
especially if they have not had an emission during the night. 
If they wake early, and get a reasonably good meal, and their 
circulation is equalized, there is less tendency to local con- 
gestion. The morning meal may consist of clam stew, a very 
palatable article for weak stomachs, and a couple of soft boiled 
eggs, with a plate of wheaten grits and cream, or oatmeal and 
cream, and a pint of milk, fresh from the cow. The watered 
milk will not answer in these cases. Sometimes I order a raw 
egg dropped in iced water, or iced milk, before the cereals, 
with perhaps a cup of weak coffee, or English breakfast tea. 
If chops are desirable, I order them as above, to be preceded 
by oranges or other suitable fruits. Let the patient take tea or 
coffee instead of milk or plain water. 

After breakfast a brisk walk should be taken for about half 
an hour. If the weather is bad the walking can be done in- 
doors. If much fatigue is experienced from half an hour's 
walk, the time may be shortened. 

At eleven a. m. the patient can have one or two raw beef 
sandwiches, with a cup of weak tea or hot milk. The raw 
beef should be carefully prepared by taking a tender steak, 
freeing it from fat, and then scraping it with a knife until the 
red pulp of the meat is separated from its cellular tissue. This 
pulp includes all the nutritious elements of the beef, and con- 
tains nothing that is not easily digested. Indeed it is the most 
nutritious and most easily digested article of diet that I am 
acquainted with. When prepared with a little salt it is exceed- 
ingly palatable. There is nothing in its taste then, to remind 
the patient of unprepared raw beef. There is some of the taste 
of raw beef in badly cooked meat, none in the really raw 



CONSTITUTIONAL TREATMENT OF IMPOTENCE. 22 1 

meat. I have given it to infants suffering from cholera 
infantum, with good effect. It is often retained in these cases 
when food in any other form is vomited. 

If the patient cannot take this meat in the form of a sandwich, 
it can be given in teaspoonful doses five or six times each day. 

At two o'clock the heaviest meal of the day is to be taken. 
A full meal in the evening is not admissible. The dinner may 
consist of mutton broth, thickened with barley or pea-soup, 
with some of the marrow of the beef bones mixed with it, fol- 
lowed by chops or broiled chicken or beef. Broiled meats are 
always to be preferred. Fried fish maybe substituted for meat 
or added to the bill of fare. Vegetables, such as potatoes, 
beans, peas and spinach, are generally beneficial. Asparagus, 
beets, onions and carrots are not to be used unless the patient 
has some special desire for them. For dessert, rice or tapioca 
pudding will be necessary. All the ordinary forms of pastry 
should be excluded. Fruit, such as apples, pears and peaches 
are to be indulged in sparingly. When the stomach has regained 
some of its lost tone, they may be given in greater quantities. 

With the dinner, a small bottle of claret or a glass of sherry 
may be taken. I am aware that in prescribing any form of 
of alcoholic stimulus, I am running counter to the advice of 
many in the profession, who consider total abstinence from all 
stimulants a desideratum in the treatment of every form of 
spermatorrhoea. They oppose the use of stimulants for the 
same reason that they object to oysters and other articles of 
diet which are said to increase the activity of the genital ap- 
paratus. My experience, however, has taught me that a mild 
stimulant in the form of claret, taken at dinner or at intervals 
during the afternoon, is an indispensable adjuvant in the treat- 
ment of the patients belonging to the first two classes of cases. 



222 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 

It assists digestion, gives tone to the stomach, and limits the 
nervous depression ; and owing to its astringency it must have 
some effect in diminishing the secretion of the glands connected 
with the genitals. I have never seen it display a tendency to 
increase either the nocturnal or diurnal pollutions. Even if 
the emissions were temporarily increased by its use I should 
not hesitate to give it, for I regard its assistance in strengthen- 
ing the patient as more than compensating for any seminal 
losses which its general stimulating action might produce. 
There are other drinks which may be used with benefit besides 
claret. Pilsner lager is often relished and readily digested. 
ApoUinaris and imported seltzers may also be employed in- 
stead of plain water. Sweet cider is not objectionable. Beef 
tea made in a bottle, bouillion, and hot milk are both pleasant 
and nutritious. 

The lightest meal of the day should be taken in the evening. 
Nothing in the shape of food should be taken after that meal 
unless the patient is in a very low state. The meal should be 
served at six, in order that the principal part of the digestive 
process may be completed before the patient retires to bed. 

For supper the patient may eat a few raw oysters, stewed 
clams, a little cold chicken or boiled rice. A cup of tea and 
toast will suffice for many, and will be much better than a 
heavier meal. Some get along very well with bread and a glass 
of milk for the evening meal. If the milk seems to disagree 
with the stomach, a tablespoonful or two of lime water should 
be added to the goblet of it before using. It makes no differ- 
ence whether the sensation of hunger ceases or not from the 
food taken into the stomach. The quantity of food must be 
less than that taken at any other period of the day. A patient 
will sleep better with the stomach comparatively empty, than 



CONSTITUTIONAL tREATMENT OF IMPOTENCE. i2^ 

with a full meal. A hearty meal in the evening makes the di- 
gestive function active and continues it into the hours neces- 
sary for sleep, and is consequently provocative of unpleasant 
dreams, restlessness, insomnia, and seminal emissions. 

Liquids of all kinds should be abstained from after the six 
o'clock meal, unless the patient be very feverish and thirsty. 
The less water the bladder has to throw off during the night 
the better. When the bladder is distended the congestion about 
the prostate and other parts is increased, and emissions are 
more Hable to take place. If a drink is necessary, a cup of hot 
milk or hot water will be found to answer. It excites the action 
of the perspiratory glands, takes some of the work away from 
the bladder, and assists in relieving congestion. 

All spices or spiced food is apt to exert an injurious effect in 
spermatorrhoea. Spices of all kinds stimulate the genital 
organs, without giving any nourishment to the system. 

Coffee is more injurious than tea. In many cases coffee 
may have to be dispensed with altogether, but, as before stated, 
it may be given largely diluted. When there is a choice the 
preference should be given to tea. 



CHAPTER XIII. 



TENCE, AND ALLIED DISEASES. 

Condition of the Bowels in Spermatorrhoea — Scanty Secretion — Diminished 
Peristaltic Action — Why Cathartics are Contra-indicated — Effects of 
Constipation in Increasing the Number of Seminal Emissions — Semen 
Evacuated at Stool — Cases in which Small Doses of Calomel may be 
Employed — Action of Belladonna and Physostigma on the Bowels — Injec- 
tions of Oil into the Rectum — Cold Water Enemata the Best Remedy for 
Constipation in Spermatorrhoea — Local Effects of the Injection — Cold 
Water Bathing — Various Methods of Employing Cold Water in the 
Treatment of Spermatorrhoea and Impotence — Cold Sponge Bath — Sitz 
Bath— Shower Bath— Rubbing Bath— Cold Douche Bath— Sea Bath- 
ing — Temperature of Bath for Weak and Nervous Patients — Local and 
General Effects of the Bath — Sleep and Exercise. 

All patients suffering from spermatorrhoea and impotence are 
likewise subject to constipation. The disease is characterized 
by a lack of secretion in the intestinal glands and by diminished 
peristaltic action of the intestinal muscular fibres. As a conse- 
quence the fecal evacuations are extremely hard and infrequent. 
They are usually accompanied by violent straining efforts which 
cause great distress. In many instances the fecal matter 
accumulates in large quantities in the rectum, presses upon the 
vesiculge seminales and prostate gland, occasioning consid- 
erable irritation. This irritation invariably increases the fre- 
quency of the seminal emissions. 

This fecal mass must be removed, and the lethargic condition 
of the bowels changed to an active and normal one, at the 
beginning of the treatment. Healthy and regular fecal evacua- 



CONSTiTUTiONAL TREATMENT OF iMPOtENC£. 225 

tions must be promoted, or the remedies for the cure of the 
original disease will be almost useless. For patients belonging 
to the first and second classes, cathartics are not 
admissible. For patients belonging to the third 
and fourth classes, mild cathartics are generally 
beneficial. When cathartics are administered to debilitated 
patients, they increase the relaxation which already obtains, and 
diminish the strength. To persons who can bear the medicine, 
and who are subject to bilious attacks, I usually prescribe 
eight grains of calomel or double doses of two grains. Each 
two grain powder may be taken at intervals of five hours. The 
morning after, a glass or two of Kissengen (or any other 
cathartic water) may be taken, the Kissengen, however, being 
the most effective and desirable. The mineral water should be 
continued for three or four weeks, in sufficient quantities to 
produce regular evacuations from the alimentary canal. It is 
essential to establish the habit of moving the bowels every 
morning. And the patient should attempt to evacuate the con- 
tents of the intestines every day at a certain hour, whether the 
inclination to do so is present or not. If this plan is continued, 
good results will certainly follow. 

In some cases, I found compound rhubarb pills to act with 
excellent effect, being useful for patients belonging to the 
third and fourth classes. It is not necessary to give a full 
cathartic dose of these pills. One pill each night, or every 
other night, will gradually bring about the desired effect. If 
one pill at night should produce more than one evacuation 
in the morning, half a pill may be administered instead. A pill 
composed of belladonna, physostigma and nux vomica may be 
employed with great advantage. (See page 244.) 

Another excellent method of increasing the alvine evacua- 
15 



±26 CONSTItUTIOiJAL TREATMENT OF IMPOTENCE. 

tions, is to inject before retiring an ounce or two ounces of 
sweet oil. The oil generally remains in the rectum all night, 
without producing any unpleasant sensations. The bowels are 
usually emptied in the morning. The most satisfactory method 
of emptying the bowels in all cases where there is general 
debility, is to administer an enema of cold water every morn- 
ing after breakfast. From one to two pints will be sufficient. 
The nozzle of the syringe should be warmed and oiled, and the 
water injected slowly and carefully ; the injections should be 
continued until the bowels acquire the habit of moving daily. 

The cold water injection may occasion unpleasant sensations to 
the patient unaccustomed to its use, and it may even cause 
considerable pain in the perineum and around the base 
of the bladder. This, however, should not deter the patient 
from a faithful trial of the remedy. For, usually, after the 
fourth or fifth injection all disagreeable feelings cease. 

A twofold effect is usually obtained from these injections of 
cold water. The bowels are emptied in a natural manner 
without any resulting weakness, and the congestion around the 
vesiculae seminales and neck of the bladder is immediately dimin- 
ished. The stream of cold water thrown from the syringe 
impinges on the parts mentioned, the dilated bloodvessels con- 
tract, thereby relieving the engorgement, and producing a more 
natural circulation in all the tissues of the parts concerned. 
Coincident with this decreased congestion there is necessarily 
less irritability of the nerves and a diminution in the secretions of 
the glands which furnish materials for the seminal fluid. The 
emissions in consequence become less frequent. Besides this, 
the muscular fibres connected with the prostate derive more 
tone from the cold water. And as muscular contraction has 
much to do with the erectile power, this added tonicity develops 



CONSTITUTIONAL TREATMENT OF IMPOTENCE. 227 

greater permanency in the erection. I have known these in- 
jections in three cases to produce natural erections without the 
employment of any other remedial agent. 

All these agents are assisted by friction over the bowels, with 
the hand or with a brush. If the hand is employed the move- 
ment is made from the caecum upwards to the ribs, then across 
over the transverse colon and then down in the course of the 
descending colon and sigmoid flexure. The amount of pres- 
sure made must depend on the sensitiveness of the patient ; as 
a rule it should be very firm. These movements may be re- 
peated for half an hour at a time, in the morning and evening, 
and may be supplemented by a general rubbing of the whole 
body. 

COLD WATER BATHING. 

The use of water as a remedial agent has of late years become 
universal. The indiscriminate use resulting from the first hy- 
dropathic fever has been replaced by systematic and scientific 
methods of application which have been obtained by a prac- 
tical study of its local and constitutional effects on the 
economy. The therapeutical action of cold water is well un- 
derstood, and its efiicacy in many disorders satisfactorily es- 
tablished. Especially in the treatment of spermatorrhoea and 
impotence it has been found to be a valuable and indispensable 
adjuvant. It may be employed in these affections both locally 
and generally in the form of 

Cold sponge baths. 

" Sitz baths. 

** Shower baths. 

" Douches. 

" Hubbing. 



■■■ 



228 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 

I usually commence treatment with the cold sponge bath. It 
should be taken in the morning upon getting out of bed. If the 
patient is very weak, the bath is not admissible. Re-action is 
slow in debilitated persons. They feel chilly and uncomfort- 
able, because much of their animal heat is abstracted by 
the cold water, and their heat-making power is not sufficient 
to make up for the loss. Much discrimination therefore is 
necessary in prescribing the bath. The majority, however, of 
patients suffering from spermatorrhoea react remarkably well 
after the bath. 

The water of the first bath should have a temperature of about 
sixty degrees, and should be of a three minutes' duration. Sub- 
sequently, baths may be taken in water below sixty, of five 
minutes' duration. The patient prepared for the bath stands 
by the side of the tub on a warm rug and after dipping the 
sponge in the cold water, rubs it rapidly over the face and 
neck, drenching the parts thoroughly four or five times. Then 
the arms from the shoulders down receive the same applica- 
tion. When the arms are finished the patient should get into 
the bath-tub and while standing up apply the sponge to every 
part of the lower extremities. The next step is to sit down in 
the water and thoroughly sponge the surface of the chest, abdo- 
men and spinal column. By pressing the wet sponge on the 
back of the neck, the whole back is reached by the water. 
There or four repetitions of this process will be sufficient to com- 
plete the bath. 

After the patient leaves the bath he should be rubbed with a 
dry coarse towel until the integument is dry and red. The 
patient should himself apply the surface friction, as this ne- 
cessitates considerable action of the muscles, conduces to the 
development of caloric, and ensures reaction. Even where 



CONSTITUTIONAL TREATMENT OF IMPOTENCE. 229 

there is a tendency to chilliness the brisk rubbing by the patient 
will prevent any unpleasant termination to the bath. 

In case the patient's debility prevents him from taking the 
bath as directed, the sponging may be done in bed, or a towel 
may be used instead of the sponge. The sponge or towel is first 
applied to the face and neck. When these parts are dried, each 
arm should be washed and dried. Then the lower extremities, 
abdomen, throat and back receive the same application and 
rubbing as the head and neck. Sometimes, when the circula- 
tion is very bad and the hands and feet are cold, I am in the 
habit of applying a flannel saturated with alcohol to the whole 
integument as soon as the water bath has terminated and the 
skin is dry. 

These applications of cold water at first produce contrac- 
tion of the capillary bloodvessels and more rapid circulation of 
the blood. When reaction takes place, there is a determination 
of blood to the integument which increases the secreting and 
excreting functions of the skin and assists in relieving internal 
congestions. The muscular tone is increased and nervous 
irritability removed. The patient feels stronger and his mind 
is clearer after the bath than before it, and he is better fitted 
in every way to attend to daily work. 

The sitz bath likewise is productive of excellent results 
when properly employed in the treatment of spermatorrhoea 
and impotence. The bath is taken in a zinc tub shaped 
somewhat like an arm-chair without legs and having a large 
back for the patient to rest against while he sits in the water, 
with his lower limbs resting on the floor outside of the bath. 
The water at sixty degrees should fill one-third of the tub, 
and the patient's shoulders, arms and legs are covered with 
blankets or other material which will keep the body comfortably 



230 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 

warm. The water covers the upper half of the thighs, the geni- 
tal organs and the lower half of the abdomen. 

The length of time the patient should remain in the bath 
must be governed entirely by the stage of the disease and the 
general condition of the patient. As sound judgment must be 
exercised in the employment of this bath as in the use of any 
other therapeutical agent. For the first class of patients one 
bath at uight before retiring will be sufficient if the cold sponge 
bath was taken in the morning. If not, two baths, with an 
interval of two hours between will be necessary. Each bath 
must not exceed five minutes in duration. For patients of the 
second class one sitz bath of eight minutes duration will be 
necessary every four hours ; the last bath should be taken at 
bed-time. These frequent sitz baths have a remarkable effect 
in removing chronic distension of the bloodvessels within and 
without the pelvic cavity. A direct tonic and stimulating 
effect is exerted upon the genital organs, which is soon felt by 
the patient, and the frequent employment of the bath continues 
these effects. Each one assists in keeping up the contraction 
of the bloodvessels, prevents further engorgement, so that in 
the course of time they resume their natural caliber and no 
more blood circulates in the organs than is needed for their 
functional activity. 

For patients belonging to the third and fourth class a sitz 
bath each night of fifteen minutes' duration, in water at the 
same temperature as previously is advised. Sitz baths continued 
this length of time have more of a sedative and derivative action 
than the five-minute baths. Their action extends to remote 
organs ; they relieve congestion of the brain to some extent, 
and promote sleep. They generally relieve the insomnia 
of patients suffering from spermatorrhoea when other remedies 



CONSTITUTIONAL TREATMENT OF IMPOTENCE. 2$l 

fail. The alimentary canal also is affected by the bath. The 
constipation is removed and healthy and regular evacuations 
are the result. 

Gully, who has made a specialty of the water treatment, 
and who has had an immense experience says : " The sitz 
bath is admirably adapted to the treatment of active 
irritations, as well as conditions of obstruction, so that it 
is applicable in almost all cases of chronic, as it is in very 
many acute, diseases. The sitz bath is used either as a tonic 
or a derivative. In the former case it is taken cold and for a 
time varying from five to fifteen minutes, seldom exceeding the 
latter period. The rationale of its operation in this character 
is sufficiently simple. The stimulus of the cold causes the 
bloodvessels of the parts and neighborhood to which the 
water is applied to contract, and thereby rid themselves of any 
excess of blood, and as this stimulus has not been carried to 
any great extent, there is very little subsequent return of 
relaxation in those vessels ; still there is some, and it is for this 
reason that it becomes necessary to apply the stimulus again 
after short intervals ; short sitz baths always require frequent 
repetition, sometimes as often as six or seven times in the 
twenty-four hours. It will appear from the above that the 
short or tonic sitz bath is applicable in all cases where 
there is an enfeebled or congested state of the parts 
contained within the hips, for instance, in excessive menstrua- 
tion, leucorrhoea, loss of muscular tone and protrusion of the 
lower gut. 

" The temperature at which it is fit to take the sitz bath is 
important. Its tonic effect is best, and indeed only obtained 
by the cold degrees ; that is under sixty degrees. . . . Patients 
in a very low condition of vital activity, but in whom it is d^- 



232 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 

sirable to produce derivation of blood to the lower organs 01 
digestion, should in the first instance be submitted to water of 
a tepid temperature or nearly so, and the degree should be 
lowered as the strength increases. The amount of derivation 
in such an event is not so great nor permanent as when water 
at forty or fifty degrees is used ; but a judicious practitioner 
will suit his remedies to his patients' power and not go by blind 
rules. In applying the sitz bath in its tonic character it is de- 
sirable to use it often and this because the relaxed bloodvessels 
of the viscera of the pelvis may not have time to fall again 
into an exhausted state and re-admit fresh blood. It is chiefly 
in its derivative action that it produces a lowering effect, and 
is, therefore, adapted for certain states of active irritation of 
the digestive viscera and head. By such a bath the pulse is 
reduced in rapidity and hardness to an extent that many would 
scarcely credit. . . . Both the long and the short sitz baths 
have the effect of quieting the brain and nervous system. In 
sleepless nights the best opiate that can be taken is a cold sitz 
bath of four or five minutes' duration, and the sound sleep that 
certainly follows is well worth the exertion of the resolution to 
get up and take it. I have repeatedly known patients to fall 
asleep in a cold sitz bath of long duration, and they always 
pronounced it a refreshing sleep. Both the long and the short 
sitz bath are beneficial in removing headaches of a nervous or 
bihous kind, in staying vomiting, flatulent spasms, etc. When 
used to open the bowels it is well to rub the abdomen with the 
wet hand during the last eight or ten minutes of the bath." 

The sitz bath exercises a good effect on the erectile tissues 
of the genitals. After the first dozen baths the erections last 
longer and approximate more nearly to a healthy standard. 
The emissions are diminished and the uneasy sensations 



CONSTITUTIONAL TREATMENT OF IMPOTENCE. 233 

in the perineum and urethral canal may completely pass 
away. 

The only contra-indication to the use of the bath is the con- 
tinuance of chilly sensations after the patient retires to bed, 
and the occurrence of a pain over the sacral region which is 
aggravated by walking. These abnormal symptoms are due to 
excessive use of the cold water. In such cases the number of 
baths may be reduced to three in the week, and the temperature 
of the water may be increased to seventy degrees. As soon as the 
patient bears this without uneasiness the temperature may be 
lowered two or three degrees at a time until sixty is again 
reached. 

Shower Baths are only useful in a few cases. In previous 
years I prescribed them in almost every case of spermatorrhoea 
that came under my care. But I soon found that the over 
excitation of the nervous system produced by them more than 
counterbalanced their tonic effect. Some of these patients 
after taking the bath could not sit still or rest in one position 
for more than three minutes at a time. And this restlessness 
often lasted during the entire forenoon. They complained of 
uncomfortable sensations on the spinal column, described by 
some of them as a creeping feeling, by others as a pricking or 
tingling sensation. One case in particular maybe mentioned as 
exhibiting this peculiar effect. The patient had suffered from 
spermatorrhoea for four years. He was not particularly 
nervous or frightened as to his condition. The first shower 
bath was administered in the evening and lasted three minutes. 
Almost as soon as he had retired to bed he felt as if myriads 
of ants were crawling up and down the spinal column. Ice 
cold spots the size of a pea were felt on the lower extremities. 
He became very much frightened and passed an uncomfortable 



234 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 

and sleepless night. Next evening the same results followed 
the bath. He then allowed an interval of three days to pass 
before he repeated the bath. This one was taken in the morn- 
ing upon getting out of bed. An hour afterwards the same 
creeping sensations came on accompanied by great restlessness 
and inability to remain long in one position. The bath was 
finally discontinued and the cold sponge and sitz bath em- 
ployed. With these he suffered no discomfort whatever. 

In consequence of these peculiar results and also because of 
the fact that reaction is very much protracted after these baths 
I have discontinued them in all cases belonging to the first 
three classes. With patients belonging to the fourth class we 
get better results. These persons are often full-blooded and 
in the enjoyment of average good health with the one excep- 
tion of marked impotence. The " stirring up " which the 
cold shower occasions gives the patient renewed energy, 
awakens him for a time from his listlessnsss and depression 
and conduces to a healthy mencal action, which is an impor- 
tant result for the physician to secure. 

The cold douche is recommended by hydropaths as an effi- 
cient remedy in spermatorrhoea. I have had but little experience 
with this variety of bath, because I have found the others pre- 
viously spoken of to answer all purposes. The cold douche may 
be either general or local. In using the former, the patient sits 
in the bath tub while an assistant pours cold water on his body 
from a pitcher held some distance above the patient. Some 
prefer a steady stream from a rubber tube or pipe to the inter- 
rupted stream from the pitcher. This bath is similar in its 
effects to the shower bath. 

The local douche is often beneficial in diminishing the num- 
ber of emissions and giving tone to the genitals. The simplest 



CONSTITUTIONAL TREATMENT OF IMPOTENCE. 235 

way to give this bath is for the patient to sit on the edge of the 
bath tub with his limbs inside, and, by means of a rubber pipe 
with a suitable nozzle, he directs the stream of water to the 
perineum and genital organs. This local bath is best taken .at 
bed-time or before indulging in sexual intercourse. 

Some authorities speak highly of the rubbing or dripping 
sheet bath in the diseases under consideration. Gully says 
with reference to it: — " The dripping sheet is generally used as a 
preparative process for the skin, if that organ has been hitherto 
unaccustomed to the impression of water below its own tem- 
perature, and the shock is considerably modified by the attend- 
ant friction. The bloodvessels of the skin contract in the 
first instance, and subsequently relax, admitting more blood 
into their calibre, — a double action, which is reiterated by the 
friction, until a good amount of blood is fixed in the skin, to 
be maintained by subsequent exercise. But besides this, the 
stimulating impression made upon the myriads of nerves of ani- 
mal life spread over the skin, and derived from the brain and 
spinal cord, modifies the circulation in these last, and, through 
them, affects the vital energies of the viscera. It is in this 
manner that it takes off languor, gives alacrity to mind and 
limb, clears away intellectual and moral cloudiness, at the same 
time that it generates appetite, removes thirst, causes expulsion 
of flatulence, etc. More than this, its repeated and frequent 
use will reduce some of the symptoms of very intense derange- 
ment of the animal nervous system, such as attacks of tic and 
violent spasms of the limbs and trunk. 

" When speaking of the wet-sheet packing, I have alluded to 
the favorable condition in which it placed the skin and viscera 
for the best reaction on the subsequent process of the dripping 
sheet. Were the patient to remain just as he comes from the 



2$6 COXSTITUTIOXAL TREATMENT OF IMPOTENCE. 

packing, his skin would be liable to take cold from the opera- 
tion of the air, the stimulus of which is not strong enough to 
ensure sufficient reaction. But when the dripping sheet, with 
the friction, comes to play upon the skin with its organic energy 
accumulated in the packing, the reaction is great, the blood 
remains in the skin, and its presence prevents the taking of 
cold. Hence it, or some cognate process, is indispensable 
after the wet-sheet packing. For this purpose, it is sometimes 
prudent, in cases of great organic feebleness, to commence with 
a tepid sheet, and only gradually reach the cold temperature. 
But when it is used alone, for the purpose of refreshing the 
animal nerves and the brain, or for reducing their painful or 
spasmodic affections, it should always be cold, and the accom- 
panying friction long and continued. Six or eight sheets in 
succession are sometimes thus administered. To ver}- delicate 
persons I often apply, in the first instance, only friction of the 
trunk and arms with a wet towel, dry and dress those parts, and 
then have the lesrs rubbed in like manner. Reaction and com- 
fortable sensation may thus be obtained, which would be want- 
ing were an entire sheet thrown at once over the entire body. 
In persons with apoplectic heads, such a commencement is 
likewise advisable. As the dripping sheet, although less stim- 
ulant, answers in some degree the objects of the shallow bath 
presently to be mentioned, it is a good substitute for it when 
that bsth is difficult to obtain, as in traveling. If there be 
feverish pulse and heat, the dripping sheet taken at bed-time in- 
duces sleep, by relieving the brain from the irritation of the skin. 
But if there be no signs of feverishness, it will rather prevent 
sleep by exciting the skin, which then exckes the brain." 



COisrSTITUTIONAL TREATMENT OF IMPOTENCE. 237 

EXERCISE. 

Active exercise is an indispensable adjunct in the treatment 
of all forms of genital weakness. It promotes digestion, and 
assists in relieving the congested condition of all the viscera. 
Whatever exercise is advised for the patient should be taken at 
various intervals during the day, and should not be crowded on 
the patient at one time. From two to three hours after each 
meal is the best time for exercise. The amount of it must be 
determined by the strength of the patient. If he should be 
too weak to walk or ride, manipulation and friction of the sur- 
face of the body should be given twice each day by a compe- 
tent manipulator engaged for the purpose. This passive exer- 
cise will answer all purposes until the patient regains sufficient 
strength to exercise himself. 

Boxing is an excellent indoor exercise. It brings into play 
every muscle of the body. It keeps the mind active as well 
as the muscles. It stimulates the circulation in every part and 
increases the strength of the patient. Exercise in boxing, even 
if carried to the extent of fatiguing the patient, is nevertheless 
beneficial. 

Dumb bells and indian clubs are also serviceable means of 
exercise. They may be used four or five times each day, for 
about fifteen minutes, without injury. The benefit derived 
from this employment is not, however, so great as that derived 
from boxing. 

Outdoor exercise should never be omitted. Walking, run- 
ning, rowing, riding are all excellent in their proper time and 
place. Two hours after breakfast is an excellent time to walk ; 
and a brisk walk of from half an Jiour to an hour, even if the 
patient is fatigued by it, will produce good results. 



I 



2^8 CONSTITUTIONAL TREATMENT OF IMPOTENCE. 

Horseback exercise is good when there is not too much irri- 
tation of the genital organs. In irritable cases I have known 
the exercise to increase the number of seminal losses. The 
cases that are benefited by it are those whose trouble is chiefly- 
mental, as it is in the fourth class of cases. Indeed, in all per- 
sons in whom the mental trouble preponderates over the local 
trouble in the genitals, horseback exercise will do a vast amount 
of good. 

SLEEP. 

The sleeping apartment of a patient suffering from sperma- 
torrhoea should be large and well ventilated. The windows of 
the room should be kept open night and day. The free cir- 
culation of air is always to be continued without respect to 
the peculiar opinions on the subject entertained by the patient 
or his friends. The windows should be closed only when the 
baths are taken. 

A feather bed is not so good to sleep on as a hard hair 
mattress. The covering of the bed should be sufficient to pre- 
vent the patient from taking cold, but not enough to induce 
perspiration. Linen sheets are preferable to cotton in summer 
and winter. Ten o'clock is a good hour for retiring. The 
patient should rise at six o'clock in the morning or earlier, even 
if he has passed a sleepless night. It is best to rise and bathe 
and eat. If further sleep is necessary, it can be obtained after 
the exercise prescribed by the physician has been taken. 

It is always advisable to sleep on the right or left side. The 
former is the best. When the patient lies on the back, emis- 
sions are more apt to occur. To obviate the tendency to lie 
on the back, an ordinary wooden reel maintained in place over 
the lumbar region by a cord* can be used to good purpose. 



CHAPTER XIV. 

TREATMENT OF SPERMATORRHCEA AND IMPOTENCE AND 
ALLIED DISORDERS (CONTINUED.) 

Indications for the use of Tonic Medicines — Cases in which they are benefi- 
cial — Reasons for their Discontinuance — Effects of Strychnia on the 
Spinal Cord — Combination of Strychnia, Iron, Quinia and Glycerine — 
Tonics and Nerve Stimulants in Nervous Depression — Preparations to be 
employed when there is obstinate Constipation, Palpitation of the Heart, 
Vertigo, etc. — Employment of Arsenic, Iron, Nux Vomica, Ergot and 
Quinia — Aphrodisiacs — Special Indications for their Employment — Classes 
of Patients benefited by their use — When they should be discontinued — 
Peculiar effects of Phosphorus on the Nervous System and Genital 
Organs — Dangers connected with its administration — Compound phos- 
phorus Pills — Cantharides as an Aphrodisiac — Best mode of administra- 
tion — Combination of Ergot, Nux Vomica and Capsicum — Effect of Can- 
nabis Indica, Ergot, Nux Vomica, Quinia — Sanguinaria, Stillingia, Water 
Pepper, Damiana, etc. — Homoeopathic Remedies. 

Tonic medicines are indispensable in nearly all cases of 
spermatorrhoea and impotence. Tonics which combine a stimu- 
lating effect on the genital organs with a general restorative in- 
fluence, can be more advantageously employed than the simple 
tonics ; or, simple tonics may be combined with medicines 
whose action is specially exerted upon the genital functions. 
All medicinal agents lose their effect when continued for any 
great length of time. It is well, therefore, to change from one 
preparation to another as soon as improvement ceases. Five 
weeks is a sufficient length of time for the employment of any 
one medicine or combination of medicines. 

Again, certain preparations act beneficially in one case and 
obtain negative results in another. They may suit the stomach 



^40 TREATMENT OF IMPOTENCE, ETC. 

of one patient and disorder the digestive functions of another. 
Hence, the necessity for a careful discriminating selection in 
all cases. When medicines disagree with a patient for more 
than a couple of days they should be discontinued and another 
set of remedies substituted. Nothing is gained by persevering 
in the use of a drug obnoxious to the patient, or failing to do 
its work within a reasonable period. 

One of the best tonic combinations for cases of spermator- 
rhoea and impotence is the following : — 

]^ . Strychniae Sulphas. . , . gr. i, 

Quiniae Sulphas. , , . | ss. 

Tinct. Ferri Chloridi • . . | ss. 

Glycerinae . • . . | iv. 

Misce. 

Half teaspoonful in a wine-glass of water four times each 
day. To be taken before meals if it does not disorder the 
stomach. 

This combination has a local as well as a general effect. The 
strychnia, by sending a greater amount of blood to the spinal 
cord, stimulates the action of the nerves given off to the genital 
organs, and gives tone to the muscular fibres concerned in 
erection. The preparation of iron increases the quantity of 
red globules in the blood and exerts a special tonic action on 
the genito-urinary apparatus. The quinine is a general tonic 
and stimulant, and the glycerine, besides being a pleasant 
vehicle for the bitter drugs, assists the stomach digestion. 

When there is general nervousness and depression of spirits, 
a nervous stimulant should be added to the tonic remedies. The 
following combination containing phosphorus in connection 
with the iron and chloric ether, will be found to produce good 
results •— 



TREATMENT OF IMPOTENCE, ETC. 



241 



5. Strychniae Sulphas. • . . gri. 

Quinine Sulphas. • . . 3 ss. 

Ferri Pyrophosphat. . • . 3 ii. 

Spts Chloroformi ... 3 iii. 

Glycerinae . . . • § iv. 

Misce. 

One teaspoonful in a wine-glass of water four times each day. 
In cases where flatulence is a common and painful symptom 
the following preparation will often answer : — 

5. Tinct. Nucis Vomicae . . . 3 ii. 

Tinct. Capsici 

Tinct. Hydropiper. . . . aa 3 iii. 

Tinct. Cinchonae Comp. . . . | ii. 

Spts. Lavend. Comp. ... § iii. 

Misce. 

A dessertspoonful in water four times each day. 
This combination, through the water pepper it contains, ex- 
erts a stimulating effect on the genital organs. If the number 
of emissions are increased by its use the drug may be omitted. 
Or the following combination may be used for the same pur- 
pose if the capsicum, as it sometimes does, disagrees with the 
stomach : 

;^. Bismuth. Subnitratis . . . . 3 ii. 

Pulv, Zingiberis | ss. 

Tinct. Hydropiper § i. 

Spts. Lavend Comp. ,,.... | iii. 

M. 

One teaspoonful four or five times each day. 

Two drops of nux vomica may be given in a wineglass of 

water before each meal, and the above preparation may be 

given after each meal. 
t6 



242 TREATMENT OF IMPOTENCE, EtC. 

In cases where the patients are subject to bilious attacks the 
bowels should be thoroughly cleansed with the following 
simple combination of cream of tartar and Epsom salts and 
afterwards nux vom. may be administered in two or three drop 
doses in water before meals, and nitro-muriatic acid in five drop 
doses after each meal. 

]^. Magnesias Sulph. 

Potassii Bitartras. aa | i. 

Aquae Oi. 

M. 

One or two wineglassfuls before breakfast. 

If the patient has been in the habit of drinking he may be 
given a wineglassful every hour till four or five doses have 
been taken, and afterward take the medicine before breakfast 
in the small dose. 

The passages produced by this medicine are unattended with 
pain, and great relief is usually experienced in all cases where 
the medicine is indicated. 

In some patients insomnia is a prominent as well as a most 
obstinate symptom. These cases in addition to their baths 
(see p. 227) need sedatives that will not disorder the stomach or 
retard the assimilation of food in any way. The following I 
have found beneficial : 

]^. Tinct. Lupuline . • • • . 

Tinct. Hyoscyami , . . • * S,S. %u 

Tinct. Valerianae . . • • 

Tinct. Gentianae 

Spts. Vini Rectif. . . • . aa | ii. 

One dessertspoonful in a wineglass of water three or four 
times each day. A double dose may be taken at bedtime. 
The action of this medicine may be accelerated by placing 



TREATMENT OF IMPOTENCE, ETC. 243 

over the stomach and praecordlum a muslin handkerchief wet with 
tinct. of capsicum diluted with alcohol sufficiently to prevent 
pain. I have found it useful in many cases. I have also used in 
addition to tonics in cases of insomnia parvules of morphia and 
atropia at bedtime (morphia g^o? atropia jio), with good re- 
sults, but I do not advise their continuous use. They should be 
employed only in cases of emergency, when it is absolutely nec- 
essary for the patient to get a good night's sleep. 

When there is weakness of the heart and a tendency to 
syncope, as there often is, especially in females, the following 
may be used : 

5 . Tinct. Digitalis • . . . • 3 iii. 
Tinct. Ergotse .... . |i. 

Spts. Ammonise Aromat. . . . | ss. 

Tinct. Valerian | iiL 

M. 

One teaspoonful every two or three hours. 

Or as a temporary stimulant : 

^5 . Spts. Ammonise Aromat | ss. 

Spts. Vini Gallici | ii. 

M. 

Half teaspoonful in a wineglass of water every half hour or 
hour until the faintness has passed away. Not more than six 
consecutive doses should be given. 

Some patients prefer medicine in the solid state. The fol- 
lowing is an excellent combination : 

^. Ferri Arseniatis 

Ext. Nucis Vomicae . . . . aa grs. v. 

Ergotinae . . . ; . 

Quinise Sulphas. . . . . . aa 3 ss. 

M. Ft. pil. No xxx. div. 



244 TREATMENT OF IMPOTENCE, ETC. 

One pill four times each day. 

The ergotine and nux stimulate the circulation of blood in 
the genital organs. The former is supposed to reduce the 
calibre of the bloodvessels, thus diminishing the congestion 
which exists in these parts. 

When constipation is a prominent symptom the combination 
of aloes and nux in the tonic preparation will exert a beneficial 
effect. 

5. Ferri. Sulph. Exsiccata . , . . 3 ss. 

Ext. Nucis Vomicae .... grs. v. 

Pulv. Aloes Soc * grs. xv. 

Ext. Gentianse . ... • . grs. xx. 

M. Ft. pil. No. XXX. div. 

One pill three times each day. 

Sometimes palpitation of the heart and vertigo are trouble- 
some symptoms. When such is the case the following pre- 
paration may be employed with benefit : 

B. Ex. Digitalis 

Ex. Belladonnas . . . . . aa grs. 

Quiniae Sulph. 

Ferri Phosphas aa 3 ss. 

M. Ft. pil. No. XXX. div. 

One pill four times each day. 

As soon as the palpitation and vertigo are relieved this pre- 
paration should be discontinued and one of the other tonics 
prescribed. 

Physostigma is a useful addition to the tonic or other medicines. 
T have employed it successfully in combination with belladonna 
as a laxative in torpid conditions of the intestinal canal depend- 
ent upon sexual excess and masturbation. It is also useful in 
any other condition where it is essential to secure a natural 



i 



TREATMENT OF IMPOTENCE, ETC. 245 

movement of the bowels, without depleting the patient. 
Bartholow recommends a combination of physostigma, bella- 
donna and nux vomica in the following formulse : 
5. Tinct. Physostigmatis .... 
Tinct. Nucis Vomicae .... 
Tinct. Belladonnas . . . . aa 3 ii. 
M. Sig. Twenty drops in water morning and evening. 
I have had better results from the solid combination than the 
liquid. 

B. Ext. Physostigmatis .... 

Ext. Belladonnse 

Ext. Nucis Vomicas . . . aa grs. v. 

M. Ft. pil. No. X. div. One pill at bedtime. 
Aloin may sometimes be added to the above with benefit. 

APHRODISIACS. 

When tonic medicines have been employed for two or three 
weeks, aphrodisiacs may be given to increase the frequency 
and permanency of the erections. While the genital organs are 
irritable, relaxed, and the emissions frequent, they should not 
be employed. But when all irritability has been removed by 
the local and general treatment, and the patient about to ex- 
ercise his genital functions, their use will be beneficial. 

Aphrodisiacs are of little use in patients of the third class, 
or those whose genital organs are in a state of constant excite- 
ment, whether that excitement is, or is not connected with par- 
tial or complete impotence. They increase the congestion 
and cause a vast amount of trouble. 

When the impotence depends on mental emotion they can 
be administered at the commencement of the treatment. In no 
other instance can this be done. Even in these cases electricity 



^46 TREATMENT OF IMPOTENCE, ETC. 

should be first used. Applications of electricity, hereafter to be 
described, rarely fail to cure the impotence. There is no abso- 
lute necessity to use aphrodisiacs in mental impotence at the 
onset. But I have found that if some positive excitement is 
produced at the beginning of the treatment by medicinal agents 
that recovery took place rapidly. For these patients usually 
lose all hope at the first failure, and are only relieved of these 
depressions when there is a perceptible improvement in their 
virile power. 

All aphrodisiacs cause a determination of blood to the geni- 
tal organs. Some do this by acting as a local irritant — others 
by stimulating the cerebro-spinal center. They all exert an 
injurious influence on the stomach when continued for any 
great length of time ; when they disturb the digestive functions ; 
or cause trouble in any other way they should be discon- 
tinued. 

Phosphorus is one of the best aphrodisiacs in the list. It is 
a powerful stimulant to the genital organs. It increases the 
desire for sexual intercourse without producing any local irri- 
tation in the genital apparatus. It also diminishes the anaemic 
condition of the brain and furnishes it with material that has 
been lost through excess. Bartholow says, " We have no remedy 
at present more effective in the treatment of impotence than 
phosphorus." The great objection to its use is its unvarying 
tendency to disorder the stomach. In consequence of this it 
must be given in very minute doses, and its effects carefully 
watched. It should not be administered on an empty stomach. 
The drug may be given in solution or in pill form. Half a 
grain of phosphorus may be dissolved in an ounce of cod-liver 
oil, and half a teaspoonful of the mixture administered after 
meals until there is a manifest increase in the frequency 



TREATMENT OF IMPOTENCE, ETC. 247 

and power of the erections. It may be given combined with 
nux vomica as in the compound phosphorus pills. Each pill 
contains ^ of a grain of nux and i J o of phosphorus. One 
pill may be given twice each day, until the desired result is at- 
tained. As soon as symptoms of disordered digestion appear, 
the administration should be discontinued for a few days and 
then resumed. If the medicine still disorders the stomach, it 
may be stopped permanently and another aphrodisiac substi- 
tuted. 

Cantharides is second only to phosphorus as a stimulant to 
the genital organs. It produces an increased flow of blood to 
the whole genito-urinary tract without exaggerating the desire 
for sexual pleasures. In over doses it causes priapism, strang- 
ury and inflammation of the genitals. Its effects, therefore, 
should be carefully watched. 

The tincture may be given in ten drop doses four or five 
times daily until it produces its specific physiological effects. 
Better results are obtained, however, by combining it with other 
drugs such as ergot, nux vomica, cannabis indica, or cap- 
sicum. 

The root of petroselinum sativum is possessed of qualities 
which entitle it to rank as an excellent aphrodisiac as well as 
emenagogue. The active principle apiol may be given in five or 
fifteen grain doses, two or three times each day. It is especially 
indicated if there is any malarial complication. Water pepper or 
polygonun hydropiperoides is also a useful and at the same 
time harmless aphrodisiac. In mild doses it stimulates the circu- 
lation, promotes digestion and increases the menstrual flow, and 
promotes erection. Eberle believed it to be a specific in amen- 
orrhcea. Bartholow says, *' it is a remedy of considerable 
power in functional impotence. When the erections are feeble, 



248 



TREATMENT OF IMPOTENCE, ETC. 



the seminal fluid watery, and the testes soft, great results will be 
obtained from this remedy, provided no structural alterations hin- 
der or prevent improvement. When hydropepper is administered 
in these disorders of the sexual system, it causes a feeling of weight 
and tension, and dragging of the pelvic viscera. As it tends to 
increase the blood supply to these organs, it is inadmissible 
when a state of congestion or inflammation exists." 

The leaves of ruta graveolans also increase the flow of blood 
to the genital organs. Hence, it is useful as an aphrodisi- 
ac though most frequently employed as an emenagogue. The 
oil is principally used in doses of from one drop to five after 
meals. 

Stillingia, sanguinaria and other remedies are used much 
for the same purpose. The following combination can always 
be relied on to do excellent work : 

5t. Tinct. Hydropiper. .... § iss. 

Tinct. Nucis Vomicae 



Tinct. Ergotae 
Tinct. Rutae 
Spts. Vini Galilei. 
Spts. Lavend. Comp. 



3ii. 



aa I ss. 



aa |ii. 



M. One teaspoonful in water four or five times each day, 
or the following : — 

^. Tinct. Cantharidis. .... 

Ext. Ergotae, fl aa 3 1 

Tinct. Nucis Vomicae .... 

Tinct. Capsici aa § ii. 

Mix. 

Dose, half teaspoonful In a wineglass of water four times 
each day. To be discontinued on the manifestation of any un- 
pleasant symptoms. 



TREATMENT OF IMPOTENCE, ETC. 249 

Bartholow recommends a preparation containing : — 

5. Tine. Sanguinarise, 3 iii. 

Ext. Stillingiae, 3 v. 

M, Fifteen to twenty drops in water three times a day. 
If solid preparations are preferred, the following combina- 
tion will be found exceedingly useful : — 

5. Ext. Cannabis Indicse .... grs. x. 

Ext. Ergotse ...... 3i 

Ext. Nucis Vomicae .... grs. iv. 

Pulv. Capsici grs. xv. 

M. Ft. Pil. No. XXX, div. 
One pill four times each day. 

Damiana is the latest aphrodisiac medicine. It has been 
largely advertised, and is said to have an excellent effect in 
promoting erections. Not having used it I can express no 
opinion concerning its medicinal or physiological effects. 

In many cases of impotence it will be found necessary to 
continue the ordinary tonic medicine during the day and give 
an aphrodisiac at bed time. A simple and at the same time a 
valuable mixture, is the following : 

5. Pulv. Capsici ..... grs. x. 

Quinise Sulph. . . • . , grs. v. 

Spts. Vini Gallic! . . • • | ss. 

Aqu3e. ..... I ii.^ 

M. 

To be taken in two doses, one hour apart. 
The administration of stimulants at bed time, uncombined 
with drugs, are often necessary for patients whose impotence re- 
sults from fear. Brandy or champagne are about the best 
stimulants for the purpose. 

In this connection it will be well for the benefit of those who 



250 TREATMENT OF IMPOTENCE, ETC. 

are curious on the subject to mention the peculiar remedies ad- 
vised by the homoeopaths. Gillman says : " Aconite is indi- 
cated by great nervous derangement ; sudden starting at the 
least noise, fitful mood, apprehensions for the future, dizziness, 
frontal headache, dryness of the tongue, distress in the pit of 
the stomach, smarting of the egesta, wakefulness at night, 
drowsiness in the day time, nightmare, copious emissions. This 
agent will be found of no use in this disease unless it is ad- 
ministered in the form of tincture in a tumbler of water, a tea- 
spoonful every three or four hours until a decided improvement 
sets in. 

*' Nux vomica may be given, one dose of the 6th att. every 
other night, if the patient complains of costiveness, bad taste 
in the mouth, soreness of the stomach, constipation. 

" Mercurius vivus is adapted to the following symptoms : 
pappy mouth, thinly coated tongue, altered taste, sallow com- 
plexion, chilliness, great sensitiveness to air, costiveness. The 
alvine evacuations being composed of hard balls or lumps hav- 
ing a dark color. Give a powder of the third trituration every 
night. 

" Carho vegit. will be found adapted to constipation, with 
heartburn, acidity of the stomach, distress after eating, disten- 
sion of the bowels. If the agent should not relieve the patient, 
phosphorus may be substituted, especially if the nervous system 
is very much shattered and the patient complains of oppres- 
sion on the chest, tendency to cough, pains in the chest. This 
medicine should be used alternately with China if the patient 
is very weak. 

" Acidum muriaticum in complete impotence, relaxation of the 
penis, complete absence of all erections and a sense of weak- 
ness in the parts, 



"Agnus castus, for frequent emissions, aversion or indiffer- 
ence to sexual intercourse, deficient erections. 

" Argentum nitricum : Deficient sexual desire, shriveling of 
the genital organs. 

" Camphora : Weakness of the parts, want of sexual desire 
and erections, coldness of the parts. 

" Cannabis : Aversion to sexual intercourse, with coldness of 
the genital organs. 

** Colocynthis : Complete impotence, complete loss of sexual 
desire. 

" Conium maculatum : Impotence, deficient erections, im- 
perfect or short lasting erections. 

" Ignatia amara : Impotence with a feeling of weakness in 
the hips. 

" Lycopodium : Aversion to intercourse of several years 
standing, with impotence. 

" Magnesia carb. : Deficient erections, loss of sexual desire, 
aversion to intercourse, no erection even when dallying with 
a female. 

" Selenium : Impotence with desire for coitus. 

" Sulphur : Impotence with amorous fancies. 

" Stramoniu?n : Complete impotence. 

" Sabadilla : Relaxed penis with amorous fancies, insensi- 
bility to sexual excitement, aversion to dallying with females, 
diminished sexual desire. 

" Thuja : Indifference to female society." 

It is interesting to remark that Dr. Gillman assists the action 
of these remedies by the persistent use of electricity. 



CHAPTER XV. 

LOCAL TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 

Electricity the principal remedial agent in impotence — Effects of the induced 
or Faradic current — The continuous current — Electro magnetic batteries — 
Cases illustrating the effects of electricity — Various methods of using the 
electrodes — Position of the patient — Urethral and rectal electrodes — Wire- 
brush cauterization as a means of cure — Solid and liquid caustics — Lalle- 
mand's porte caustique — Precautionary measures to be adopted — Usual re- 
sults of the operation — Caustic solutions safer — Instruments for introducing 
caustic solutions to the prostatic portion of the urethra — Acupuncture — 
Introduction of the needles — Regions in which the needles are inserted — 
Results of acupuncture — Use of astringent and anodyne applications — 
Medicated bougies — Spermatorrhoea rings — Electric rings — Rectal pes- 
saries. 

Hippocrates treated cases of spermatorrhoea and impotence, 
by first giving an emetic, and then confining the patient to milk 
and decoctions of barley and leaves. Since his time the majority 
of practitioners have depended mainly on local treatment to 
promote a cure. IMany cases, indeed, can be cured by local 
remedies alone. The list of mechanical appliances and medici- 
nal agents employed in or upon various portions of the genera- 
tive apparatus is a long one. The majority of them I have 
never used, nor do I intend to use them, while there are other 
and better means of accomplishing the desired end. But, as 
they are recommended by many in the profession, v»^hose experi- 
ence is worthy of consideration, they are given in the following 
list in their order of value, and as recommended by others : 

Electricity, 

Cauterization, 

Astringent and anodyne applications, 



Local treatment of spermatorrhcea & impotence. 253 



Introduction of medicated bougies, 


(t 


" Steel sounds, 


Acupuncture, 


Application 


of electric rings, 


(( 


" Spermatorrhoea rings, 


u 


" Rectal pessaries. 




ELECTRICITY. 



Electricity is the most useful of these remedial agents. There 
is no other agent which is capable of exerting such a beneficial 
influence on a// cases of spermatorrhoea and impotence. In fact, 
it should supersede, as it has in my hands, all other forms of 
local treatment. I have used it invariably in every case which 
has come under my care during the past ten years, and have 
rarely found it to fail in accomplishing all that is claimed for it. 
Electricity, when judiciously employed, removes in a short time 
the irritability of the mucous membrane in the prostatic urethra 
and seminal ducts, upon which the frequent nocturnal and diur- 
nal pollutions generally depend. It restores the bloodvessels to 
their normal calibre, and stimulates the circulation through 
them, thus removing the congestion which always obtains in the 
relaxed tissues of the masturbator. It increases the nervous 
force, and gives tone to the muscular fibres connected with the 
genital organs. 

Either the induced or continuous current may be employed. 
Having found the induced or Faradic current to answer every 
purpose, I do not employ the continuous, though in many 
hands the latter has done excellent service. The induced 
current is recognized by most authorities as more beneficial 
than the continuous in cases of spermatorrhoea and impotence. 



254 LOCAL T^EATMENt OF SPERMATORRHCEA & IMPOTENCE. 

Meyer's general conclusions as to the cases in which induced 
electricity is indicated, point at once to its applicability in the 
diseases under consideration. He says : — *' The induced cur- 
rent is applicable in those cases in which we want — 

" a — To excite the muscles, the nerves of sense, the sensory 
or the motor nerves." 

"^ — To produce contractions of the blood or lymphatic 
vessels." 

" c — Or to affect organs supplied from the sympathetic." 

There are many varieties of batteries in the market. Among 
the best are those manufactured by Kidder, Fleming, of Phila- 
delphia, and the Galvano-Faradic Co. 

The applications of electricity are best made when the patient 
is in a recumbent posture, though they can readily be given 
while the patient is sitting or standing. When the battery is 
ready for use and the patient's hips, back and genitals exposed, 
the urethral electrode insulated to within an inch of its point 
is attached to the negative pole of the battery. The other 
electrode with a moistened sponge on its extremity is attached 
to the positive pole. The urethral electrode well oiled and 
warmed is slowly introduced through the urethral canal to the 
neck of the bladder, while the sponge covered electrode is 
placed over the genito-spinal center at the junction of the 
dorsal with the lumbar vertebrse, and moved up and down over 
the vertebral column as far as the tip of the coccyx. While 
the sponge is being moved over these parts the urethral elec- 
trode is slowly withdrawn until its point reaches the bulbous 
portion of the urethra. There it is allowed to remain until the 
termination of the se'ance. When the sponge covered elec- 
trode has been applied posteriorly about five minutes, it can 
be carried around to the perineum, and moved slowly up 



tOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. ^$^ 

and down from the line of the scrotum to the anus until the 
sitting is ended. 

The first stance should not exceed seven or eight minutes, 
and the current should be very mild. If the application is 
protracted, and the current intense enough to produce pain, too 
great a sedative action may be produced which may have to 
be counteracted by stimulating medicines. Besides this the 
urethral electrode, by mechanical irritation alone, may cause 
local inflammation if it remains too great a length of time in 
the canal. 

At the second stance the day following a wire brush may be 
substituted for the urethral electrode. This is passed slowly 
over the inner side of the thighs, perineum and scrotum at the 
same time that the sponge covered electrode is passed over the 
lumbar, sacral and ischio-rectal regions. The second stance 
should last for ten minutes. On the third day the urethral 
electrode may be employed again. And this alternation of the 
latter with the wire brush may be continued until the close of 
treatment. If the urethral canal of the patient is not too sensi- 
tive, the urethral electrode may be employed every day, 
alternating at the same sitting with the wire brush. 

When there are large quantities of prostatic fluid poured out 
or squeezed out during defecation or where there is enlargement 
of the gland, it will be well to use the rectal electrode. This 
instrument when warmed and oiled is introduced into the rec- 
tum, slowly and gently until it reaches the posterior border of 
the prostatic gland, when the current is passed through from 
the urethra to the rectum. 

When the nocturnal emissions are reduced to one a week, 
and the erections are still feeble and infrequent a greater 
stimulating effect on the erectile tissues may be effected bv 



256 LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 

changing the direction of the current ten or fifteen times dur- 
ing the seance. This method usually increases the frequency 
and permanency of the erections. 

If the impotence is complete, this method should be employed 
from the commencement of the treatment. 

In this connection one or two instances of the peculiar effects 
of electricity in spermatorrhoea and impotence will be of 
interest. 

Four years since a teacher in one of the public schools ap- 
plied to me for relief. He was twenty-two years old, of good 
habits and capable of performing his business duties with satis- 
faction. He commenced masturbating when a boy of nine and 
continued the habit until the age of nineteen. Thereafter 
seminal emissions occurred with varying frequency. Some 
months they occurred as often as five times a week. He had 
essayed sexual congress on different occasions with bad results. 
At the time he came under my care he had from three to five 
emissions in the week. He was running down rapidly and in 
great distress of mind concerning his condition. He intended 
taking a vacation in the country the day after his visit. I gave 
him but one application of electricity in the manner previously 
described, and prescribed a tonic medicine, containing 
strychnia, iron, quinine and glycerine. Four weeks subse- 
quently he returned from his vacation and, much to my surprise, 
informed me that only one seminal loss had taken place during 
the interval, and that occurred the morning of his return to 
town. As his former trips to the country had made no special 
difference in his condition, I was compelled to ascribe the 
principal part of healthy change to the application of electricity 
made on his first visit. This, of course, is an exceptional case. 
The majority of patients feel the effects of electricity in dimin- 



LOCAL TREATMENT OF SPERMATORRHOEA & IMPOTENCE. ^5^ 

ishing the number of emissions very gradually, yet the results 
in this instance indicate the curative power which electricity 
possesses in spermatorrhoea and impotence. 

An average result of the electrical treatment is illustrated by 
the following case : — 

J. S., aet 29, occupation book-keeper, came under treatment in 
March 1877. He had indulged in onanistic exercises during 
his school-boy days. At the age of eighteen he cohabited with 
a servant at varying intervals for a period of two years. Subse- 
quently circumstances compelled him to refrain from any in- 
dulgence for six years, during which time he had emissions two 
and three times each week. He was then (March '77) contem- 
plating matrimony, but his state of health was such that he 
feared he would be unable to fulfill his engagement, or perform 
his matrimonial duties with satisfaction. His memory was not 
so good as in former years, and his ability to endure mental and 
physical labor comparatively small. 

He received applications of electricity every other day for 
two months ; took cold water sponge baths and tonics during 
the same period. At the end of the first month an interval of 
ten days had elapsed between the last emission and the present 
one, and his virile power was increased, as evidenced by 
the character of the erections. He was discharged at the end 
of the period mentioned and entered the marriage state, feeling 
well and competent to perform all his functions properly. He 
has been married eight months and has suffered no incon- 
venience from his previous disorder in any particular ; he con- 
siders himself perfectly well. 

In all cases where the nocturnal emissions have been re- 
duced to one in a week or ten days, and the erections occur 
Hightly, the patient is in a fit condition to marry. Marriage 
17 



25^ LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCil. 

should take place as soon as the patient leaves the hands of the 
physician, in order that the healthy condition commenced by 
the treatment may continue without interruption. Wedlock in 
itself and independently of everything else, is a means of 
cure which should never be lost sight of. The patient even 
when diffident and fearful, may rest assured that at the end of 
a few weeks at the most his virile power developing strength 
from a natural source will supply all normal demands made 
upon it. 

CAUTERIZATION. 

This operation may be performed with either solid or liquid 
caustic preparations. Applications of solid caustics are usually 
made with Lallemand's porte caustiques. I do not advocate 
cauterization of the prostatic urethra when electricity is avail- 
able, but there is no doubt it is the next best thing, and is pro- 
ductive of excellent results. The method of employing Lalle- 
mand's instrument may best be described in his own words : 

"Before proceeding to cauterization it is indispensably 
necessary to introduce a catheter for the double purpose of 
taking the exact length of the urethra and of completely 
emptying the bladder. On slowly withdrawing the instrument 
during the escape of the urine, the stream is arrested as soon as 
the eye of the catheter enters the canal, and recommences 
again when it is again pushed into the bladder. The penis 
being then moderately stretched the thumb and forefinger 
should be applied to the instrument at the point of the glass, 
when the catheter is withdrawn. The distance between the 
finger and thumb and its eyes give the exact length of the 
urethra, and this must be immediately marked on the porte 
caustique, the eyes of the olivary instrument and the position 



LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 259 

of the fingers indicated by fixing a little slide on the stem of 
the instrument. When the porte caustique has penetrated so 
far into the urethra that this slide touches the front of the 
glans, the penis being exactly in the same state of elongation 
in which it was when the catheter was introduced, it is clear 
that its extremity will be in precisely the spot previously 
occupied by the eyes of the catheter when the length of the 
canal was taken, that is to say at the commencement of the 
neck of the bladder, a position which it is highly important to 
the operator to be assured of. 

" The bladder must be completely emptied in order that no 
urine may penetrate into the tube of the porte caustique, and 
that none may enter the urethra during cauterization. When 
the caustic is wetted by the urine it acts much less energeti- 
cally than if it were dry, and its action extends to parts where 
it is not required. 

" As the olivary extremity of the porte caustique approaches 
the neck of the bladder the irritability of the passages increase 
and the patient's agitation often becomes so great as to incon- 
venience the operator. The instrument should now be allowed 
to pass on by its own gravity, attention being paid to detect the 
moment when the olivary extremity passes the neck of the blad- 
der. As soon as this happens the instrument should be gently 
withdrawn, so as to bring its olivary extremity slightly within 
the neck of the bladder, and firmly held while the outer tube is 
a little drawn back and the curette very rapidly passed over the 
inferior surface of the prostate by slightly turning the stem 
attached to it. The instrument then should be entirely closed 
and slowly withdrawn from the urethra." 

Lallemand claims a large number of cures by this process. It 
15 readily seen that if the operation is properly performed^ the 



26o LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 

granulations which exist in the prostatic urethra will be dis- 
troyed and the irritability lessened. This being the case, a 
diminution in the number of the seminal emissions must neces- 
sarily result. The great objection to the operation, however, is 
that great pain is produced by it, and severe inflammation of 
the urethra and bladder is liable to follow it. In the only case 
it was employed by me considerable bleeding followed the 
withdrawal of the caustic. * 

ACUPUNCTURE 

Is one of the most ancient operations for the cure of sperma- 
torrhoea and impotence ; Lallemand and other surgeons of his 
time employed it successfully. 

Needles from two to three inches in length are passed through 
the perineum into the prostate gland and neck of the bladder. 
Before the operation is performed the patient's bowels should 
be emptied and the urine drawn off. The first needle is intro- 
duced in the median line midway between the anus and 
scrotum. The second is inserted into the prostate half an inch 
below the first, and the third needle is introduced half an inch 
above the first one. They are kept in position half or three 
quarters of an hour. In no instance should they be allowed to 
remain over an hour. If much pain is caused by the operation 
an opiate may be administered. 

Some surgeons recommend the introduction of needles into 
the testicles and spermatic cord for the same purpose. The 
operation is a barbarous one and should not be attempted. 

With regard to the effects of acupuncture, Lallemand says : 
" The patients experience, immediately after removal of the 

* Since the above was written I have employed the porte caustique in 
three other cases without producing much bleeding. 



LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 26 1 

needles, a sense of comfort and suppleness which extends from 
the perineum to neighboring parts, and remarkable improvement 
in all the phenomena caused by disordered innervation of the 
genital organs usually results. Sometimes, indeed, such dis- 
orders do not i:e-appear. 

COUNTER-IRRITATION. 

Counter-irritation, to cause a determination of blood to the 
surface, is often used to relieve the irritability of the genitals 
which occasions the emissions, and also to prevent the confirmed 
masturbator from handling the parts. Counter-irritants are 
seldom if ever necessary except for the latter purpose. Any 
diminution in the congestion produced by them is merely 
temporary. In case it is found necessary to employ them can- 
tharadal collodion or a fly blister may be used. Painting 
the parts with tincture of iodine will answer where mild 
measures are necessary. Croton oil is a dangerous counter- 
irritant and should never be applied to the genitals, as 
it is apt to produce a severe degree of inflammation and 
sloughing. 

Astringent and anodyne injections have long been used in 
the treatment of spermatorrhoea and impotence. At best they 
are only palliative. They merely diminish for a time such un- 
pleasant accompaniments of the disease, as prostatorrhoea, cow- 
peritis, and allay the irritability existing at the orifice of the 
seminal and prostatic ducts. 

Syringes, with nozzles six or seven inches in length, and 
having several perforations at their extremities, injection 
catheters, etc., are employed for these deep urethal injections. 
Dr. Bumstead's syringes are the best for the purpose. The in- 
jection may be made with an ordinary urethral syringe if the 



262 LOCAL TREATMENT OF SPERMATORRHOEA & IMPOTENCE. 

Others cannot be had, by pressing the fluid in the urethra back- 
wards with the finger after the syringe is withdrawn. When it 
has reached the neck of the bladder, by relaxing the sphincter 
as at the commencement of micturition the liquid can be 
pressed into the bladder. 

One of the simpler astringent remedies is the following : 

^ . Acidi Gallici 3 iii. 

Glycerinae | i. 

Aquae liv. 

Misce. 

One syringeful of this solution may be injected at bed 
lime. 

In some cases alum is useful in the proportion of one drachm 
to four ounces of distilled water. One injection each night. 
If there is much smarting at the neck of the bladder it must be 
discontinued. 

When a sedative as well as an astringent effect is required 
the following combination will be found of benefit : 

5. Ext. Hyoscyami 3 ii. 

Vini opii 3 i. 

Acidi Gallici 3L 

Glycerinae | iv. 

Misce. 

One tablespoonful of this mixture added to an equal quantity 
of water may be injected twice each day for one week, unless 
pain at the neck of the bladder is excited by its use. In such 
a case the number of injections may be limited to one each 
night or every other night. If the injections are employed 
twice a day for one week, thereafter they should be used every 
other day. 

Injections containing ergot are often used, such as : 



LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 263 



5 



3i. 
3ii. 



Ext. Ergots fl. . 
Ext. Uva Ursi fl. 
Aquae 
Misce. 

One teaspoonful in a wineglassful of water ; inject once each 
day. 

A number of unguents are used for medicated bougies. The 
ordinary ung. gallae combined with ung. opii is a useful 
one. The ointment is smeared thoroughly over the extremity 
of the bougie or sound. The instrument is then passed down 
to the neck of the bladder and allowed to remain there for ten 
minutes. 

The following combination is as good as any that can be 
used : 

5 



Ext. Belladonnse 






Ext. Hyoscyam. , 




aa grs. v. 


Pulv. Opii • 




grs. ii. 


Acidi Gallici 




grs. X. 


Cerat. Simpl. 




3ii. 



M. 

A thick layer of the ointment is placed on the bougie for 
about two inches from its extremity. When introduced to 
the neck of the bladder it may be allowed to remain for five 
minutes. This preparation may be introduced daily. 



INTRODUCTION OF SOUNDS. 



The daily introduction of steel sounds has been advocated 
by many surgeons. They claim that the presence of the sound 
in the prostatic portion of the urethra, empties the congested 
and dilated bloodvessels, promotes absorption of inflamma- 



264 LOCAL TREATMENT OF SPERMATORRHOEA & IMPOTENCE. 

tory products and gradually removes the irritability of the sem- 
inal passages, thereby diminishing the number of pollutions. 

My experience with sounds has taught me that but little 
benefit can be expected from their employment, except in neu- 
ralgia of the neck of the bladder. 

ELECTRIC RINGS. 

The electric ring is an ingenious contrivance for awakening 
the patient before an emission occurs. The ring is placed around 
the penis at night and connected with an electric belt which is* 
placed around the abdomen, the latter being attached to the 
poles of a battery. When there is a determination of blood 
to the genital organs during sleep, the whole tissue of the penis 
becomes distended, the ring expands and separates the wires 
which prevent the patient from feeling the electric current 
while the organ is quiescent. As soon as the separation takes 
place a violent shock is experienced which awakens the sleeper 
in time to prevent an emission. This instrument was invented 
by Johnson of New York. He calls it an electric monitor. 

Steel rings armed with sharp teeth on the inner surface are 
also employed for the same purpose. The ring is placed on 
the penis before going to bed ; when erection takes place the 
sharp points pierce the integument and the pain arouses the 
sleeper. Leather rings furnished with teeth or pins are also 
recommended for a like purpose. 

In some cases when the patient cannot get intelligent ad- 
vice or treatment such devices may be employed for tempo- 
rary relief ; otherwise, they should never be advised. 

RECTAL PESSARIES. 

Pessaries shaped like an egg and inserted into the rectum 
so as to press on the ejaculatory ducts and prevent the semen 



i 



LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 265 

from entering the urethra have also been recommended. No bene- 
fit can arise from their employment. It would be better for the 
patient to put up with an emission than to have an egg pessary- 
introduced into his rectum every night. 

RECAPITULATION. 

Patients belonging to the first class (see page 207) are ex- 
tremely rare. They are nearly always beyond the reach of 
moral or medical treatment. The will power not being suffi- 
cient to control the habit, ordinary treatment is wasted. It 
may be well to exercise strict supervision over the patient, and 
use the baths, tonics and electricity for a few weeks, and then if 
there is no good result, the patient should be castrated without 
delay, and the penis, pubes and perineum covered with canthara- 
dal collodion. Simple castration will not at once stop ejacula- 
tions through the urethral canal, so it is consequently necessary 
to place the parts in such a condition as to prevent them from 
being handled. If these measures fail, I see no objection to 
removing the whole of the external genital apparatus. 

Patients of the second class (see page 208) are always curable. 
Though very much broken down, their will power is sufficient to 
enable them to discontinue the habit completely. Let the 
patient understand that he can be cured by following up sys- 
tematically every order given him. He should take from three 
to six sitz baths daily for the first ten days or a fortnight. After 
that period one or two will be sufficient. If the baths cause 
much aching about the loins and difficulty in locomotion, they 
should not be used so frequently. The pain and stiffness do 
not often occur, but when present, contra-indicate the frequent 
use of the bath. Every morning after breakfast an injection of 
one pint of cold water should be taken. This can be con- 



: 66 LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 

tinued daily, until the evacuations from the bowels are normal 
in character. Three or four weeks is generally long enough to 
accomplish this end. If the patient is not strong enough to 
take a sponge bath in the morning he should be bathed while 
in bed, and after the bath have a brisk rubbing. Instead of 
eating three meals per day, he should have six or seven as de- 
scribed (page 221). Exercise in the open air is indispensable. 

The applications of electricity may be made every day or 
every other day in the manner described (page 255), with this 
difference that the current should be reversed often during the 
sitting, in order to get the stimulating effect of the application. 
Nothing tends so much to a cure as an increase in the erections. 
The moral effect of this upon the patient cannot be over- 
estimated. As the increase in the virile power is not attended 
by more frequent emissions, there is nothing to add to the anxiety 
of the patient. If ordinary aphrodisiacs were used to accom- 
plish the same purpose, an increased number of emissions 
would at once result. Therefore, the use of aphrodisiacs at 
this stage is inadmissible. The only medicines to be employed 
from the commencement of the treatment are those which give 
tone to the system (see page 241). 

When the emissions are brought down to one or two in a 
week and the erections occur every night, it is well to advise 
legitimate sexual intercourse. No fear need be entertained of 
failure if the patient is willing to follow the advice of his phy- 
sician. If necessary the patient may take a few doses of some 
of the aphrodisiac combinations previously mentioned, before 
testing his powers in sexual congress, and he may be allowed 
to continue them for a couple of weeks after marriage. 

Bromide of potassium and all medicines of a like nature 
should be strictly prohibited to all patients of this class. 



LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 267 

Patients of the third class (see page 209) make up a large 
majority of the subjects who present themselves for treatment. 
The undue excitement of the genital organs evidenced by fre- 
quent but feeble erections and frequent emissions, re-acts on 
the circulation and their mental excitement and fears form the 
principal features in the case. They require judicious advice 
more than they do medication. If they could be induced to 
marry, and wait for a week or two before becoming disheartened 
at temporary failures, they would need no other cure. But 
their fears are so urgent that a systematic course of treatment 
is necessary to get them in a proper frame of mind for 
marriage. 

A sponge bath in the morning and a sitz bath at night of 
fifteen minutes* duration are always necessary. The cold water 
enema may also be employed, but some of the mild cathartics 
will answer as well. When the genital excitement is very great 
a few doses of bromide of potassium given at bed-time for the 
space of one week will do good. It should never be continued 
longer than a week. Applications of electricity may be made 
every day, with the negative electrode in the urethra and the 
positive electrode over the spine (see page 255). The current 
need not be reversed until the patient has been under treat- 
ment five or six weeks. 

Aphrodisiacs are never necessary for patients belonging to 
this class unless failure should occur after marriage. 

Patients of the fourth class (see page 210) should cease from 
all attempts at sexual intercourse for several weeks, or months, if 
necessary, and make a short or long trip into the country with en- 
joyable company. Take in all the change of air and surroundings 
as will keep the mind away from all sexual matters. They should 
exercise actively in the open air and bathe freely, according to the 



268 LOCAL TREATMENT OF SPERMATORRHCEA & IMPOTENCE. 

directions in a previous chapter. Upon returning home they 
should make up their minds not to attempt sexual intercourse 
for three or four nights at least, and not then until they have 
perfect control of themselves in every way. 

Female masturbators can only be cured by marriage. The 
general health must receive the same attention as in the case of 
the male masturbator. The tonics, baths and other remedial 
agents described are all necessary, but marriage itself is the 
only positive cure. If circumstances are such as to prevent 
the patient from entering the married state and the will power 
is not strong enough to prevent her indulging in the vice, then 
amputation of the clitoris may be considered. Indeed, I think 
it would be a perfectly justifiable operation in all bad cases. 

It is well also to make liberal use of bromide of potassium in 
these cases so long as it does not materially disorder the stomach. 
For obvious reasons the bromides may be more freely used in 
cases of female onanism than in cases occurring in the other 
sex. 

Cold sitz-baths should be given freely. 



CHAPTER XVI. 

TREATMENT OF SPERMATORRHCEA AND IMPOTENCE, 

Methods of Treatment used by Gross, Van Buren and Keyes, Post, Bar- 
tholow, Hutchinson, McGraw, Gant, Acton, Humphrey and others. 

In order to make this volume complete as a book of refer- 
ence, I have collected the opinions of some of our principal 
surgeons, and given their various methods of treatment. Their 
peculiar views can be compared and an intelligent opinion 
formed as to the respective merits of each mode of treatment. 

Prof. Samuel D. Gross, of Philadelphia, in speaking of the 
treatment of spermatorrhoea says : " The milder cases after 
riddance of the exciting cause, often recover spontaneously, 
or under the use of very mild means, as a proper regulation of 
the diet and bowels, exercise in the open air, cold bathing, 
sleeping upon a hard mattress. Circumcision will be necessary 
when there is hyperaesthesia of the head of the penis from the 
irritation of retained sebaceous matter consequent upon elonga- 
tion and contraction of the prepuce. When the parts are 
morbidly sensitive leeches may be applied to the perineum, and 
use made, twice daily, of some astringent and anodyne injec- 
tion, as a solution of acetate of lead and opium, in the propor- 
tion of three grains of each to the ounce of water. But a very- 
different mode of management will be required when the 
disease is fully established, especially when it is dependent 
upon habitual onanism. The best local treatment then, at least 
in many cases, is cauterization, but before resorting to this 
expedient, the urethra should be well explored with a bougie 



270 TREATMENT OP SPERMATORRHCEA AND IMPOTENCE. 

or silver catheter, to ascertain the precise seat of the irritation. 
This will sometimes be found in front of the membranous 
portion of the urethra, but generally it is further back, at the 
neck of the bladder, or, more correctly speaking, at the orifices 
of the ejaculatory ducts and the anterior extremity of the 
gallinagenous crest, where it is often so great that the patient will 
shrink from the mere contact with the instrument. Occasion- 
ally the morbid sensibility is diffused over the whole surface of 
the urethra, from one end to the other, and then the passage of 
the bougie is liable to be followed by excessive pain and even 
syncope." [Dr. Gross then describes the process of cauteriza- 
tion which has been given in a previous chapter.] 

" Instead of the solid nitrate of silver, a solution of the salt 
may often be advantageously employed, in the proportion of 
ten to twenty grains to the ounce of water. The fluid is con- 
veyed directly to the prostatic portion of the urethra by means 
of a syringe shaped like an ordinary catheter, and perforated 
with numerous openings at the distal extremity. The injection 
should not be repeated oftener than once in six, eight, or ten 
days. 

" Cold bathing, general and local, is often highly beneficial ; 
dashing cold water against the perineum, scrotum, penis, and 
inside of the thighs is useful. Some persons, especially such as 
are of a nervous, irritable temperament, experience greater 
advantage from warm bathing than from cold. Occasionally 
marked relief arises from cold enemas repeated twice in the 
twenty-four hours. When the patient is plethoric, as is some- 
times the case in the early stage of the disease, leeches may be 
applied to the perineum, followed, if the local excitement is 
unusually great, by a blister, a small seton, or an issue. When 
the morbid sensibility of the urethra is -very extensive, obsti- 



TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 271 

nate or persistent, the treatment should be aided by the injec- 
tion, twice a day, of a weak solution of nitrate of silver 
and opium in the proportions of about two grains of the former 
and five of the latter to the ounce of water. Sulphate of zinc, 
Goulard's extract and acetate of lead also answer extremely 
well in cases of this kind. ... In some cases the irritability of 
the urethra promptly yields to the daily use of a full sized 
bougie retained for half an hour at a time. The morbid erec- 
tions so often present in spermatorrhoea are generally easily 
controlled by anodyne enemas, or by opium, belladonna and 
tartar-emetic given by the mouth at bed time. 

" The patient must sleep upon a hard mattress and every- 
thing stimulating, whether in the form of food, drink or medicine 
must be carefully avoided. The bowels must be kept soluble 
by mild aperients. Exercise in the open air is an important 
auxiliary. Riding on horseback is injurious, as it has a ten- 
dency to create undue excitement in the genital apparatus. 
Sometimes an entire change of occupation affords more relief 
than anything else. 

" Where there is great prostration of the system, with restless- 
ness and loss of sleep, the use of tonics, as quinine and tincture 
of iron with hyoscyamus or opium is indicated. Dilute 
phosphoric acid sometimes exerts a powerful restorative in- 
fluence. In such cases a change of air, and the daily use of 
the shower bath, greatly promote recovery. The diet should 
be light, but nutritious, and a glass of German wine should be 
allowed at dinner. Should there be reason to believe that the 
emissions are dependent upon cerebellar irritation, the chief re- 
liance must be upon leeches and blisters to the nape of the 
neck, cold shower baths and other soothing measures. Much 
has lately been written in favor of lupulin as a sedative in this 



272 TR^ATMEXT OF SPERMATCRJvH ^A AXD IZlPOTESCt. 

disease, but :l::urh I ':; r :rr:\:t":! e v : tii: i: hrs ::ever 
done any gcc i ::: my 'mnis ' mii s:ica a remedy is required the 
best article rha: I k-o~ ;: is :r:niideof potassium given three 
rimes a day, in d^ses rar.rir.r from twenty to thirty grains or 
under with a few drops of tincture of aconite, in half an ounce 
of camphor water. I have also used with excellent effect, in a 
number of cases, bromide of ammonium in conjunction with 
tincture of cypropedium. The action cf these medicines is 
powerfully sedative, and they are worthy of much greater at- 
tention than has hitherto been accorded to them in this parti- 
cular class of affections. 

"V.lien, by the a::--e me :..-:. res, :'r.z system has re^-aiied its 
natural tone and the sesna: anpararas its accustomed vigor, the 
best guarantee again s: rei: :t is m:::i m, L'pon this point, 
however, it is impossi: it m ; t : : : : as, " 

Van Buren and iKieyes, cm nam: :ia_ amn :'ae sa':;ec:. say: 
"When a man comes complaining cf the results of masturba- 
tion, an attentive study of his symptoms wiQ not infrequently 
disclose his disease to be hypochondria, and his malady ungrati- 
fied sexual desire with often some neuralgia of the vesical neck. 
Hi's training should consist in encouragement and continence, 
with absolute purity of thought, and subsequently marriage, to 
regulate his sexual hygiene. After marriage it is rare to hear 
any further complaint from these cases, always provided there 
is really nothing more than functional derangemen: ; : :im mt- 
tom of the patient's complaint, as is the case in :he vast 
majority of instances. 

" As for medicines, they are of little or no value ; camphor, 
bromide of potassium or lupulin might be given as placebos, but 
it is doubtful if they are of any efficacy. = Cold sponge baths, 
out-door sports, physical fatirae. sleeping in a coo! room cyi a 



TREATMENT OF SPERMATORRttCEA ANB IMPOTENCE. 2^3 

hard bed with a light covering are all useful ; eating lightly 
at night, not retiring until very sleepy and rising immediately 
on waking in the morning are powerful assistants in breaking 
up the habit, but all will be of no avail unless the morale of the 
patient be elevated, unless he keeps his thoughts pure, and 
desires, for the manliness of it alone, to be rid of his bad 
habit. 

" The treatment of diurnal pollution is by steel sounds and 
local astringents to the prostate together with most of the 
means detailed for nocturnal emission. Circumcision should be 
performed if the glans penis is sensitive. . . . 

" The use of the steel sound and electricity helps to give tone 
to the parts. The use of local astringents to the prostatic 
sinus is often of marked advantage. The best agent for 
effecting this is tannin, and the cupped sound, the most 
convenient method of applying it The ap- 
plications are to be repeated once or twice weekly, according 
to the effect, and often in a short time a change in the symptoms 
for the better is usually manifested in mild cases. Should these 
simple means fail recourse may be had to prostatic injections 
with deep-urethral syringes ; a solution of nitrate of silver not 
stronger than five or ten grains to the ounce being used. 
Failing with this, hope must be based upon the continuance 
of general and local tonic hygienic measures. The use of the 
fluid nitrate of silver with Lallemand's instrument is not 
justifiable, for fear of including the orifices of the ejaculatory 
ducts in an eschar and obliterating them by cicatrization.'* 

Professor Roberts Bartholow recommends cauterization with 

solid or liquid caustics, injection of astringents for relief of the 

local symptoms. In discussing general medication under the 

head of " Anaphrodisiacs " he says* "One of the oldest of 

i8 



274 TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 

these remedies is camphor. . . . It is not, however, a very val- 
uable remedy. To produce the desired anaphrodisiac effects 
large doses are necessary ; it frequently fails, and its action 
upon the stomach is unpleasant, giving rise to a sense of heat 
and burning, and followed by disagreeable eructations. 

" Lupulin has considerable efficacy as an anaphrodisiac, but 
like camphor it is uncertain. Conium and belladonna are 
quite as efficient if given in sufficient doses, and are considera- 
bly more certain. Conium, particularly, is not given in doses 
sufficient to produce its peculiar effects upon the genital organs, 
as ordinarily prescribed. Five to fifteen grains of the extract, 
according to its freshness and activity, may be administered at 

a single dose Conium and belladonna are, 

however, chiefly valuable when administered with bromide of 
potassium or other true anaphrodisiacs. 

*' The most important agent of this class, the most efficient 
and certain, and the least distressing in its immediate and re- 
mote effects, when purely administered, is the bromide of po- 
tassium. The anaphrodisiac property of this drug is now al- 
most universally acknowledged, but the condition of its success 
and failure have not been as definitely determined as is desira- 
ble. There are yet some skeptics who disbelieve in this prop- 
erty of the bromide of potassium. 

** Aphrodisiacs. — These are indicated under certain circum- 
stances. The tincture of cantharides is sometimes beneficial in 
in cases of great atony and relaxation. Those characterized 
by profuse mucous discharge, so-called diurnal pollutions, very 
feeble power of erection, and absence of sexual desire. It is 
contra-indicated when much hypersesthesia of the prostatic por- 
tion of the urethra exists. To prevent its irritant effects, or at 
least to reduce them to the minimum, opium, or cannabis indica, 



TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 275 

or chlorodyne, may be advantageously combined with it. The 
red or amorphous phosphorus may be given in the same class 
of cases as suggested for the tincture of cantharides. Nux 
vomica is adapted to those cases in which it is desired to restore 
the functional activity of the sexual organs after the state of 
quiescence induced by the prolonged administration of ana- 
phrodisiacs. Cimicifuga (actea racemosa) has seemed to me to 
possess considerable aphrodisiac power, and has proved useful 
in cases of long standing spermatorrhoea, accompanied by ner- 
vousness and anxiety, and diminished sexual desire. 

" Galvanism, especially the direct current, and static electric- 
ity, are often decidedly aphrodisiac, and are probably applica- 
ble to more numerous cases than any other remedy of the class. 
The moral effect of galvanism is too important to be disregarded. 

" Ergot has been much extolled in those cases in which 
emission takes place quickly with feeble erections. 

" Iron, quinine, the vegetable bitters, the mineral acids, are in- 
dicated in anaemic cases. The hygienica^ exercise, bathing, 
travel, etc., are valuable adjuncts to the remedial measures." 

In his work on therapeutics, Dr. Bartholow also advocates 
the injection of a solution of ergotin near the dorsal vein of 
the penis, in order to compress it and promote erections. 

Prof. Frank H. Hamilton says : — " If the emissions are only 
occasional, and do not affect the general health, no treatment 
is required and these constitute a majority of those cases 
which are brought under the notice of the surgeon. If on the 
other hand, both the general health and the mental functions 
are sensibly impaired as is sometimes the case, a careful inquiry 
must first be made to ascertain the cause and the proper 
measures must be adopted for its removal. In nearly all of 
these latter examples there is evidence of a loss of tone in th?> 



2-6 TREATMENT OF SPERMATORRHCEA AND IMFOTEXCE. 

entire nervous system and it will be proper to recommend plain 
but nutritious diet, mineral tonics, cold bathing with frictions, 
and out-door exercise. All stimulating liquors and tobacco 
are hurtful. The emissions take place usually at night or 
towards morning, when the patient has become warm in bed, 
and is sleeping soundly. In such cases the patient must be 
enjoined not to eat a hearty meal within four or five hours of 
retiring ; he must empty his bladder before getting into bed ; 
the bed should be rather hard and the coverings light, so that 
his sleep shall be less profound ; he must lie upon his side, 
never upon his back and if possible he should rise a little past 
midnight, or when he has been in bed about four hours, and, 
stepping upon the cold floor, empt}' his bladder again. A strict 
adherence to these rules seldom fails to prevent nocturnal 
emissions, and if the habit can be interrupted by these or any 
other measures for several weeks, the patient is on a fair way for 
^ecove^\^ The object in requiring the patient not to rest upon 
his back and to empty the bladder often is to prevent an ac- 
cumulation of urine upon the trigone and neck of the bladder 
where its presence is liable in children to cause involuntary 
discharges of urine and in those who are older involuntary 
discharges of semen. 

''As a direct means of recover}- from the morbid irritability 
of the neck of the bladder no plan is more successful than the 
application of nitrate of silver first suggested and practiced by 
Lallemand, but the instrument invented by Lallemand and em- 
ployed by most surgeons up to a very recent date, has proved 
ver}- unsuccessful and ought to be wholly laid aside. In addi- 
tion to the numerous accidents which have attended its use, 
and which have from time to time been recorded by surgeons, 
it has happened under my own observation also, that a young 



TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 277 

physician who had borrowed my instrument, turned the style 
in the wrong direction, and broke it, leaving the cut, contain- 
ing the caustic and several inches of the cord in the urethra, 
from which it was with great difficulty removed by a narrow 
urethral forceps. Since then I have ceased to use Lallemand's 
instrument myself, and have never recommended its use to 
others, but I have employed instead a method similar to that 
which I have seen more recently recommended by Mr. Erich- 
sen. A silver catheter furnished with a large number of small 
holes instead of the usual long fenestra at its vesical extremity, 
is introduced to the neck of the bladder, when a piece of 
sponge fastened to the end of the wire stylet, and saturated 
with a solution of nitrate of silver, is carried forcibly to the 
vesical extremity of the catheter driving the caustic solution 
out upon the mucous membranes. In the first experiment 
the strength of the solution is not to exceed five grains to the 
ounce. If this fails after the lapse of two or three weeks ten 
or twenty grains to the ounce may be employed. Latterly I 
have obtained in a few cases benefit from the daily introduc- 
tion of a steel sound of moderate size. 

" Beyond these measures, all of which it must be acknowl- 
edged are liable to fail, nothing but wedlock can hold out much 
promise of a cure, and this has proved successful in my obser- 
vation almost without an exception, not always immediately, 
but the improvement is generally manifest within a few weeks 
or months, and a complete cure can in most cases be assured 
after a year or two at most ; nor, in general, need any fear be 
entertained that the results on the patient will be found to have 
been injurious. Beyond a temporary incapacity resulting from 
a lack of confidence, no failure of the virile powers is generally 
experienced. 



278 TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 

" I have omitted to speak of ligature of the spermatic arteries, 
ligature of the vas deferens and castration, all of which 
methods have occasionally been practiced in extreme cases of 
onanism or entire mania. When practiced for the cure of 
onanism these measures have in most cases been successful, 
but the relief has not generally been immediate." 

Prof. Alfred C. Post sends me the following brief summary 
of his method in the treatment of spermatorrhoea and impotence : 
" I have regard to the constitutional condition of the patient 
and to the local irritation or congestion of the parts specially 
involved in the disease. As to the general condition of the 
patient, I combat debility as indicated by feeble pulse, pale 
complexion and muscular inertia, by tonic medicines, as iron 
and quinine, by cold bathing, local and general, especially salt 
water bathing, by regular moderate exercise in the open air, by 
nutritious diet, cheerful recreation and other appropriate 
hygienic means. When the prostatic part of the urethra is in 
a congested and irritated condition, I make gentle pressure 
upon it by the careful introduction of steel sounds, of as large 
a size as can be introduced without giving much pain to the 
patient. I repeat the introduction at intervals of two or three 
days. If the irritability be not relieved in this way, I make an 
occasional application of nitrate of silver to the prostatic portion 
of the urethra by means of Lallemand's porte caustique or other 
suitable instrument. I sometimes derived benefit from the use 
of ergot, giving 30 minims of Squibb's fluid extract three times 
a day in water, and continuing its use for several weeks. It is 
always important to guard against constipation of the bowels. 
Good effects are sometimes derived from stimulating diuretics 
such as diosma crenata, uva ursi, copaiba, cubebs, oil of san- 
dal wood, oil of turpentine. 



TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 279 

Dr. Joseph C. Hutchinson, of Brooklyn, says : '* In cases of 
spermatorrhoea requiring treatment, that is to say when the 
emissions occur two or three times a week and affect the gen- 
eral health, the cause of the trouble should be ascertained 
and the means for its removal adopted at once. The usual 
cause is self-pollution. The patient should be directed 
to avoid stimulants and tobacco (the latter direction is 
specially important), to have plenty of out-door exercise, 
to use mineral tonics, cold bathing, etc. He should sleep 
on a hard bed with light covering, avoid fluids as far as 
possible during the evening, empty his bladder before retir- 
ing and at any time he may awake during the night, and 
never sleep upon his back. This may be avoided by tying a 
handkerchief around the body with a knot in the center behind. 
These directions strictly adhered to will overcome the tendency 
to excessive nocturnal emissions in many cases. In the more 
obstinate cases I know of no remedy so generally useful as 
ergot. I advise 5 grs. of Squibb's extract, representing 20 grs. 
of the best ergot, three times a day. In most cases the 
hypersesthesia which exists in the neighborhood of the ejacu- 
latory ducts requires for its removal the application of altera- 
tive and astringent unguents to the affected parts. That which 
has been the most satisfactory to me is an ointment containing 
one-fourth of a grain of sulphate of copper to the ounce, 
applied once or twice a week by means of a number twelve 
cupped steel sound, to the prostatic urethra. In this way we 
obtain the benefits not only of the medicinal agent, but also of 
the sound itself, which is by no means unimportant. The 
cupped sound I have used for the last twenty years formerly 
belonged to and was used by the late Dr. Isaacs. The oint- 
ment may also be employed by means of a long pipe urethral 



28o TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 

syringe devised by myself and made by Tiemann. I have 
used with advantage urethral suppositories of butter of cocoa 
containing one-quarter of a grain of carbolic acid pushed 
down to the prostatic urethra by a steel sound and allowed to 
dissolve there. Patients may be instructed to use these instru- 
ments themselves when it is not convenient to attend in person 
as often as necessary. I formerly used Lallemand's instrument 
for applying solid nitrate of silver to the orifice of the ejacula- 
tory ducts, but abandoned it because of unpleasant effects 
which sometimes followed its use. Should these measures fail 
to promote a cure, the patient ought to be married. Wedlock 
is often successful when everything else fails. 

" In cases where impotence is the principal feature of the 
case, I have found nothing as efficient as fifteen minims each of 
the tinct. ferri chlor. and tinct. cantharides with one twenty-fifth 
of a grain of strychnia. The iron may be omitted when not 
indicated. In conjunction with the above mixture, phosphorus 
in one-fiftieth of a grain dose may be used. Very often phos- 
phorus alone is relied upon. The use of the cupped sound and 
the unguents recommended in the treatment of spermatorrhoea 
have a marked beneficial influence." 

Prof. Theo. A. McGraw, of Detroit, says : "I do not 
believe that even a daily emission of semen will do serious 
damage to a healthy vigorous man. In view of the fact that 
multitudes of men after marriage have connection with their 
wives more than once every night without suffering injury, it 
seems to me an absurdity to ascribe so much evil to seminal 
losses as is usually done by authors. Lallemand especially 
confounded the effects of long dissipations and other diseases 
affecting the genital organs with those of seminal losses. 

''' 2d. My experience teaches that young men who do not 



TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 281 

suffer from involuntary emissions once or twice a month or week, 
are rarely to be found in civilized society. This is a physiolo- 
gical necessity and it seems to me just as absurd and useless 
to order medicines and apply treatment to cure moderate 
seminal losses as it would to try to prevent a man from passing 
water. When the seminal vessels become full they will contract 
and empty themselves. 

" 3d. Young men who read trashy pamphlets on spermator- 
rhoea may brood over their fancied disease until they cause 
serious and often irreparable damage to the nerves supplying 
the genital organs. This causes loss of sexual power, increased 
irritability of the organs, and eventually an impotence which is 
not always susceptible of cure. I regard this as the result of 
the mental despondency and perverted attention, kept up as it 
often is through a long series of years. I do not believe that it 
is ever caused by the occurrence of emissions alone. 

" 4th. As regards treatment, the sine qua non seems to me to 
be, to get out of the patient's head that a seminal emission is in 
itself hurtful. He may then get his mind in healthier channels 
and get well. He will always, however, continue to have more 
or less frequent involuntary emissions until cured in marriage." 

Acton of London, says : " The first consideration on dealing 
with any case of spermatorrhoea, is to ascertain from which of 
its many causes the affection may have more especially arisen. 
Each patient may complain of some particular or well marked 
symptom to the exclusion of all others, though the affection 
itself may consist of a lesion of more than one function. It is 
therefore of great importance that this distinction should be 
clearly understood. According as one or other of the functions 
(e. g. erection, emission, or the character of the emitted semen) 
is in fault, so must the treatment vary : what may be good in one 



282 TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 

case may not be applicable in another. Having learned what 
particular symptom the patient complains of, he should be 
desired to make water into a glass which should be deposited 
at once on a stand, to be examined at leisure. It is well at the 
same time to pass an oblong bougie in order to ascertain the 
susceptibility of the urethra ... In order to cure the affection 
it is of more consequence to ascertain the i77imediate existing or 
local cause than the primary cause which may have impaired 
the function or congested the brain. 

o 

"Before attempting the curative treatment "Out preventive on^ 
should be commenced. It should be ascertained if bad habits 
exist, and if so, the patient should be told at once that unless 
they are left off it is useless for the surgeon to attempt to heal 
him. It should, however, not be concealed from the patient 
that the means about to be employed will speedily impart such 
power to the will, that by his own volition he will be capable 
of correcting habits which were previously beyond his control. 
Moderation in sexual indulgence, if not abstinence, should 
be enjoined on the married, and a promise to that effect ob- 
tained. It should be next ascertained whether constipation 
exists, whether ascarides excite the secretion, or if the pa- 
tient suffers from varicocele. If the latter complication be 
present a suspensory bandage must be worn, or what is still 
better, a varicocele ring, which the surgeon should teach the 
patient how to put on . . . 

" The patient must do his utmost to prevent emissions taking 
place, and to effect this should have recourse to all the means 
spoken of." . . . [Mr. Acton employs the measures pre- 
viously mentioned, page 224.] " In the slighter cases of sperma- 
torrhoea, these remedies may alone suffice, and as stated 
above the occasional passage of a large bougie or the glass 



TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 2^^ 

tube of the instrument hereafter to be described will suffice to 
cure the patient. If, however, these plans do not succeed, and 
if the emissions occur I have no hesitation in at once em- 
ploying cauterization." [Mr. Acton injects a ten grain solution 
of nitrate of silver with a large glass syringe,] With regard to 
its efficacy he says : " The advantages of injecting a solution 
of nitrate of silver are so manifest that I now never employ 
any other plan, and yet I have occasionally to treat some of the 
most obstinate forms that others have failed in curing. , . . 
** Remedial treatment comprises both constitutional and local 
measures. Constitutional treatment consists in the administra- 
tion of tonics to restore a healthy state of both the muscular 
and nervous systems, and in the use of sedatives to allay irri- 
tability. Of tonics, the preparations of iron are most effica- 
cious ; and particularly the sesquichloride of iron, in doses of 
from fifteen to thirty drops in half a wineglassful of water 
thrice daily. Strychnia, in doses of one-twelfth of a grain, 
made into a pill, with or without the sulphate of iron, forms a 
tonic anti-spasmodic preparation of great value. Sedatives are 
less beneficial than tonics ; yet, in spasmodic spermatorrhoea, 
a night pill of belladonna or of hyoscyamus and camphor, may 
perhaps be advantageously given to subdue the local irritability 
which favors the seminal emissions. Suppositories of pil. sap- 
onis, ten grains, are, according to my experience, preferable as 
acting topically. The cold hip-bath, or sluicing the perineum 
with cold water night and morning, is a most serviceable local 
tonic. Hygienic measures must also be carefully attended to 
as part of the constitutional treatment. A plain, unstimulat- 
ing, nutritious diet is essentially requisite, rigorously excluding 
peppers and other condiments, which are apt to irritate the 
rectum and provoke seminal emissions during defecation. 



284 TREATMENT OF SPER:iIAtORRHCEA AND IMPOTENCE. 

The stomach should never be overloaded by a heavy meal ; 
and a daily action of the bowels should be secured by gentle 
aperients when necessary. A dinner pill consisting of the 
compound rhubarb pill with hyoscyamus, will answer this pur- 
pose far better than colocynth or any other irritant purgative. 
The invigorating influence of daily exercise in the open air and 
of outdoor amusements, with perhaps change to a bracing 
climate, can scarcely be overlooked ; but relaxation from study 
or the excitement of business, and freedom if possible from 
the pressure of anxiety are no less restorative, while every 
encouragement must be given to cheerfulness and hope. All 
this constitutional treatment not unfrequently fails to cure the 
spermatorrhoea ; the local irritability of the prostatic urethra 
still remaining. Recourse must be had to the application of 
nitrate of silver along the under surface of this portion of the 
urethra, to the orifices of the ejaculatory ducts." — Gant. 

Humphrey thinks that when the emissions return, " more than 
once in a fortnight, and especially if they amount to two, three 
or more in a week, as is sometimes the case, they should receive 
attention." With regard to treatment he says : "The attention 
to these sensations, real and imaginary, and the constant dwell- 
ing upon the matter, tends, unquestionably, to aggravate the 
malady. My first effort, therefore — having requested the patient 
to burn any book or pamphlet he may have upon the subject — 
is to restore a calm and less anxious frame of mind, by assuring 
him that a great part of his apprehensions are groundless, 
giving him good hope of recovery, in great measure at least, 
recommending him to engage in out-door amusements and to 
enjoy the cheerful society of his friends, not to relinquish his 
reading, but to work less hard at it, especially towards night, 
to go to L>d early and rise early. I am unwilling to keep up 



TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 285 

the idea of invalidism by prescribing medicine or particular 
diet, and simply warn him against overloading his stomach, as 
that is likely to induce the discharges. These assurances and 
simple directions are often sufficient, and many have told me of 
the relief and happiness they have derived from them. This 
failing, and in worse cases, more particular attention must be 
paid to the digestive organs and their secretions, especially 
when the urine is turbid ; mild aperients may be required to 
prevent accumulations in the intestines, and a light diet must 
be enforced. In those who are robust, an alkali may be given 
at night, and in those who are weak, quinine or steel. Better 
than all medicines are relaxation from work, with change of 
air, traveling, and sea-side residence. Often, however, these 
cannot be carried out, or are available only for a time ; and 
under the medicinal treatment the discharges are sometimes not 
sufficiently diminished. Perhaps the intervals between them 
are lengthened, and they return two or three nights in suc- 
cession, instead of being more frequent and with more regular 
intervals. I have not found cold ablutions do much good, 
though washing the exterior of the glans penis, and keeping it 
clear of secretion, is of some service by lessening the irrita- 
bility of that part. The application of nitrate of silver by 
means of the porte-caustique to the inner surface of the prosta- 
tic portion of the urethra, where the ejaculatory ducts open, is 
unquestionably, in some cases, an efficient adjuvant to the means 
just described for checking or moderating this malady. It has 
been employed by many persons since it was brought promi- 
nently into notice by Lallemand ; and I do not know that 
mischievous results have attended its use in competent hands. 
Care should be taken that the instrument is sound, for the 
solder connecting the part which carries the caustic is liable to 



286 TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 

be decomposed. This once gave way, leaving the end of the in- 
strument and the caustic in the prostate of a gentleman whose 
urethra I was cauterizing. It was voided with the urine in the 
course of the following day, and, though he suffered more than 
was intended, no evil resulted. The caustic may be applied 
pretty freely, the instrument being known to be in the prostatic 
region by the distance to which it has been passed, and by the 
sensitiveness of the part, or, more certainly, by feeling with the 
finger in the rectum. A good deal of irritation, pain, with fre- 
quent bloody micturition and some discharge follow the opera- 
tion, with, perhaps, seminal emissions at night. These subside 
in a few days, and the good effect is at once shown by a ces- 
sation of the emissions. In many cases, however, they return 
after a period, requiring a repetition of the remedy, perhaps 
two or three times ; and in some cases no good results from it. 
I am aware that this proceeding is objected to by some whose 
opinions deserve attention as unsafe, by others as empirical, 
and by others as unphysiological and unpathological. It can 
scarcely be regarded as unphysiological, when we observe the 
effect which is produced on the whole length of a tube or a 
series of tubes by irritation at any one part of the lining mem- 
brane, especially if that part be near an orifice, how titillation 
of the fauces will cause vomiting, or of the larynx coughing, 
or of the rectum diarrhoea and tenesmus. It cannot be very 
unsafe or even injurious, or we should ere this have heard of 
more ill-effects produced by it. Neither do I think it so em- 
pirical and unpathological as some seem to regard it, mistaking, 
as I cannot help fancying, the real seat of the malady, which 
appears to me to be in the prostatic part of the urethra more 
distinctly than in any other portion of the generative apparatus. 
I judge this to be so, because there is usually a preternatural 



TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 287 

sensitiveness of that part elicited by the passage of instru- 
ments or by pressure with the finger. Frequently there is un- 
easiness or actual pain there, especially after the emissions ; 
and an irritation of this part by any cause is likely to induce 
the emissions. It is the only part in which anything distinctly 
abnormal in the sensations is experienced ; the testes, vasa 
deferentia, vesiculae seminales, show little or no tenderness or 
other sign of disturbance. We are, therefore, warranted in 
considering this part to be at fault, and in applying to it that 
salt which is often found to allay irritability or a chronic in- 
flammatory condition in other mucous membranes. Above all, 
there is the more cogent argument that good frequently results 
from its use. We must not, however, be too sanguine in our 
expectations, for, as has been already said, the benefit is some- 
times only temporary, and in some cases the treatment fails 
altogether. In some slight cases benefit is derived from the 
occasional passage of a metallic instrument into the bladder 
and allowing it to remain there ten or twenty minutes. It is 
commonly well to try this before resorting to cauterization. 
Accompanying this malady or independent of it, there is some- 
times a discharge from the urethra of tenacious fluid, like white 
of egg, in small quantity, following the urine, or expelled during 
the evacuation of the feces, especially when straining is re- 
quired for that purpose. This symptom causes great alarm to 
the patient, as he conceives that he is suffering from a con- 
tinual escape of the semen. Such, however, is not the case. 
I have examined this fluid passed by several persons, and have 
never found any spermal elements in it. It proceeds appa- 
rently from the prostate gland, and its presence in sufficient 
quantity to issue from the urethra is an indication of a relaxed 
condition of the ducts of the gland, permitting the secretion to 



288 TREATMENT OF SPERMATORRHGEA AND IMPOTENCE. 

be expressed during the voiding of the urine or feces. It 
generally ceases or diminishes under a tonic regimen and atten- 
tion to the state of the bowels. The commonly received 
opinion that the debility and other symptoms experienced in 
these cases is due chiefly to the loss of spermatic fluid, is a 
mistaken one, inasmuch as the exhaustion consequent on the 
emission bears very little relation to the quantity of the fluid 
discharged, or the amount of spermatic elements contained in 
the fluid. As the disorder progresses, and the emissions are 
more frequent, the proportion, indeed the actual quantity, of 
the spermatozoa decreases, the discharge consisting chiefly of 
the secretions of the vesiculse seminales and the prostate gland. 
The drain upon the system is rather through the nervous sys- 
tem than through the testicle, and the exhaustion experienced 
after each occasion is consequent upon a loss of nervous force 

rather than upon a loss of the secretion of the generative 

« 
organ. 

" The question of impotence, with its contingent, — the unad- 
visability of matrimony — is one on which it is difficult to write, 
inasmuch as there is not much very definite to be written. In 
deciding it, it is usually necessary to allow a considerable 
margin for the nervousness of the patient. A quiescent state 
of the organs, consequent on long control of the passions, is 
not to be regarded as an obstacle, because they may be roused 
into activity when appropriate circumstances arise ; and after 
a long continuance and frequent repetition of nocturnal emis- 
sions, the organs usually retain sufficient vigor to admit of im- 
provement under the influence of matrimony. It has happened 
to me often to be consulted on this subject, and I have very 
rarely felt it necessary to give a discouraging opinion. In the 
case of one gentleman, who from early life had been subject to 



TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 289 

very frequent emissions, who had long ceased to have erections 
or desire, and whom a variety of treatment, including cauteri- 
zation of the urethra, conducted by different persons, had 
failed to give relief, my advice was that he should remain a 
bachelor. Very soon afterwards he married and had a family. 
" It has been recommended that in doubtful cases the experi- 
mentum should be made in corpore vili. This appears to me 
to be useless as well as wrong, for the experiment thus made as 
a test is no real test, and, as might be expected, has ended in 
disappointment. I know a gentleman, in every respect, as I 
believe, well qualified to be a husband, and at one time anxious 
to be so, who has been prevented from marrying by the failure 
of this test, to which he, most reluctantly and needlessly, as- 
sented, in deference to the advice of an eminent surgeon whom 
he consulted. The indications derivable from external appear- 
ance are of little value ; and suspicions based upon them have 
repeatedly proved to be groundless. There are certain obvious 
disqualifications, such as imperfect formations or diseased con- 
ditions of the necessary organs, and an entire absence of erec- 
tions or desire. Where such disqualifications exist, matrimony 
is rarely contemplated. Where they are absent the surgeon is 
seldom justified in giving an unfavorable verdict, the instances 
being few in which, by judicious treatment, the patient may not 
be fitted for matrimony. To the encouragement to matrimony 
it is well to add the hint that though, for various reasons, the 
rite may not be at first consummated, yet that, in all proba- 
bility, it will be so before long. This may prevent unnecessary 
disappointment or despair. I have known premature separation 
carried out, indeed hurried on by the medical man, when there 
is reason to think that a little management and patience might 
have resulted in a happy union. The whole of this question is 
19 



2g6 Treatment of spermatorrhcea and Impotence. 

fraught with so much anxiety and excitement to the person 
concerned, that the mind is liable to be thrown off its balance, 
and the most deplorable consequences to ensue. In some 
cases, doubtless, there is cause for the anxiety, but in many the 
apprehensions are groundless, and happy is it if a man when 
thus racked with doubts can bring himself to make a confidant 
of, and disburden himself freely to, some judicious medical 
adviser, who will assure him that such cases are not uncommon, 
and will, perhaps, give him the often-quoted recommendation 
of Hunter, to make up his mind to abstain for a time. In all 
such cases it is necessary to take the general state of health 
into account, for any debilitating cause, such as dyspepsia, 
diarrhoea, mental anxiety, etc., especially when there are phos- 
phates or oxalate of lime in the urine — is liable to be attended 
with inability, which may be only of a temporary nature, and 
will yield to appropriate treatment. As a general rule, in the 
healthy person, the recurrence of desire and power, more par- 
ticularly the former, decreases gradually with advancing years. 
Sometimes it does not cease till a late period. This, however, 
varies much. In those who have abused the organs, or in- 
dulged their amorous propensities to excess in early life, the 
cessation takes place sooner than in others. We learn that the 
lords of the harem are not unfrequently impotent at thirty or 
forty ; and in this country the same occurs to persons who have 
been addicted to excite the organs preternaturally by giving 
way to lascivious thoughts, and in other ways. Any debili- 
tating influence, whether it be mental depression or enervating 
bodily disease, indigestion, phthisis, diabetes, etc., produces 
more or less of the same effect, and it has been remarked by 
Mr. Curling that * the testes of persons who die of chronic 
lingermg diseases are almost invariably soft and inelastic. 



TREATMENT OF SPERMATORRHCEA AND IMPOTENCE. 29I 

When incised, their internal structure seems to contain but 
few bloodvessels, is pale, apparently shrunk and dry, and the 
little fluid that can be squeezed from it is destitute of sperma- 
tozoa.' 

" It seems also that long-continued continence induces an 
earlier cessation of the capability of function than does mod- 
erate indulgence. And after long disuse the attempt to rouse 
these organs into activity at a late period of life, even if suc- 
cessful, is not altogether without risk to the general health. 
The excitement consequent on it, is liable to induce much pros- 
tration, which may be followed by paralysis, amaurosis, affec- 
tions of the heart, or other disorders. I suspect there is foun- 
dation for the remark that these ill-effects are more likely to 
occur in the case of widowers marrying after a considerable 
interval, than in those who have not been before married." 



INDEX. 



Absence of testicles, i6o 
Acne in masturbation, 73 
Acton on aspermatism, 117 

— on condition of vesiculae semi- 
nales, 45 

— on continence, 185 

— on education of youth, 23 

— on the effect of sexual excess on 
the heart, 100 

— on frequency of sexual inter- 
course, 78 

— on priapism, 178 

— on satyriasis, in 

— on sexual insanity, 107 

— on spermatorrhoea, 60 

— on the the treatment of impo- 
tence produced by continence, 
197 

— on the treatment of spermator- 
rhoea and impotence, 281 

Acupuncture in the treatment of 
spermatorrhoea and impotence, 
260 

Advertisements, quack, 21 

Age for marriage, 184 

Alimentary canal in masturbation, 

73 
Anaemia, cerebral, 174 
Anatomy of corpora cavernosa, 29 

— of corpus spongiosum, 29 

— of genital apparatus, 28 

— of glans penis, 30 

— of penis, 29 

— of prostate gland, 34 

— of the testicles, 37 
Anodyne injections, 261 
Aphrodisiacs, 245 

Araetius on spermatorrhoea, 59 
Arteries of the penis, 33 
Aspermatism, 116 

— treatment of, 118 
Astringent injections, 261 
Ataxia, locomotor, 179 
Atrophy of testicles, 160 



Baker on epilepsy produced by 

masturbation, 97 
Bartholin's glands, 41 
Bartholow on the bromides, 204 

— on spermatorrhoea, 61 

— on the treatment of spermator- 
rhoea and impotence, 273 

Bathing in the treatment of sper- 
matorrhoea and impotence, 227 
Bilious attacks, treatment of, 242 
Bladder, chronic catarrh of, 156 
— , extroversion of, 161 
— , irritability of neck of, 135 
— , neuralgia of neck of, 134 
Blandet's case of satyriasis, ill 
Blood, extravasations of, 160 
Bromide of potassium, 203 
Bourgeons on insanity from mas- 
turbation, etc., 102 
Bowels in spermatorrhoea and im- 
potence, 224 
Brown, Baker, on amputation of 
the clitoris, in 

Calculi, prostatic, 172 

— in urethra or foreskin, 160 
Cantharides as an aphrodisiac, 247 

— producing satyriasis, III 
Caput gallinaginous, 32 
Carpenter on obesity as a cause of 

sterility, 118 

Castration for neuralgia of the tes- 
ticle, 134 

Catarrh, chronic vesical, 156 

Cauterization in the treatment of 
spermatorrhoea and impotence, 
258 

Celsus on spermatorrhoea, 59 

Cerebral anaemia, 174 

Cerebellum, connection of with 
sexual instinct, 51, 52 

— , function of, 51 

— , hemorrhage into the, 177 

Chastity, 23 



294 



INDEX. 



Chylous urine, differentiation from 
seminal fluid, 50 

Classification of cases for treat- 
ment, 206 

Clitoris, amputation of, iii 

— , anatomy of, 40 

Clothing, night, 21 

Coitus, sensation in, in the female, 

41 

— , sensations terminating, 32 

Compressor urethrae muscle, 31 

Constipation, 224 

— , treatment of, 244 

Constitutional changes in mastur- 
bation, 72 

— treatment of spermatorrhoea, 
etc., 215 

Consumptives, erotic tendency of, 

95 

Consumption, traceable to mastur- 
bation, 93 

Continence, 183 

— , productive of impotence, 194 

Convulsions following the orgasm, 
78. 

Cooper, Sir Astley on varicocele, 
121 

Cord, spinal, concussion of, 178 

— , softening of, 180 

Corpora cavernosa, 29 

— , cartilaginous formations in, 159 

Corpus spongiosum, 29 

Cowper's glands, 31 

— , fluid from, differentiation from 
seminal fluid, 49 

Counter-irritation in the treatment 
of spermatorrhoea and impo- 
tence, 261 

Curling on neuralgia of the testi- 
cles, 130 

Cystitis, discharge in. differentia- 
tion of from seminal fluid, 50 

Cystotomy as a cause of impotence, 
157 

Damiana as an aphrodisiac, 249 
Damerel on urethral calculus, 160 
Deslandes on insanity from mas- 
turbation, etc., 102 
Diet in the treatment of sperma- 
torrhoea and impotence, 216 
Diseases which arise from sexual 

excess and masturbation, 92 
Dreams, lascivious, 47 



Ducts, ejaculatory, 32 

— from prostate gland, 32 

Education of youth, Acton on, 23 

— of youthful mind, 20 

— of sexual instincts, objections to, 
22 

Ejaculatory ducts, 32 

— condition of, in masturbation, 
70 

— effect of masturbation on, 32 
Electric rings in the treatment of 

spermatorrhoea and impotence, 
264 

Electricity in the treatment of sper- 
matorrhoea and impotence, 253 

Elephantiasis, 160 

Ellis on insanity from masturba- 
tion, 106 

Emission before puberty, 63 

— , frequency of, 47 

— , nocturnal, 47 

— produced by shampooing of oc- 
ciput, 51 

— seminal, 74 

— in women, 47 

Emotions, effects of certain, on 
erection, 53 

— , mental; see mental emotions. 

Epididymitis as a cause of sterility, 
118 

Epilepsy produced by masturba- 
tion, 96 

— terminating in insanity, 102 
Epileptiform convulsions following 

the orgasm, 78 
Epispadias as a cause of sperma- 

torrhsea and impotence, 157 
Erectile tissues, 29 
Erection, Kobelt on, 55 
— , mechanism of, 51 
— , partial, 56 
— , permanency of, 54 

— produced by certain emotions, 

53 
— , Rouget on, 56 
— , spasm of muscles connected 

with, 138 
Erector penis muscle, 29 
Erotic tendency of consumptives, 

95 
Esquirol on epilepsy produced by 

excessive indulgence, 98 
Eyes in masturbation, 73 



INDEX. 



295 



Excess, sexual; see Sexual Excess. 
Exercise in the treatment of sper- 
matorrhoea and impotence, 237 
Extroversion of bladder, i6i 

Face in masturbation, 67-73 

False impotence, 91 

Fear as a cause of impotence, 85 

— as an educational agent, 20-22 

— producing impotence, case of, 85 
Female, masturbation in, 40-41 

— organs concerned in masturba- 
tion, 39 

— , sensation in coitus in, 41 
Flatulence, treatment of, 241 
Flint on epilepsy produced by mas- 
turbation, 97 
Flourens on the cerebellum and 

sexual passions, 52 
Fluid, seminal, 43 
Function of prostate gland, 35 
Functions, sexual, knowledge of, 

17 
Furor uterinus; see Nymphomania. 

Gait in masturbation, 73 
Galen on spermatorrhoea, 60 
Gall on a case of excessive sexual 
indulgence, 95 

— on sexual instincts, 51 
Generative organs in female, effect 

of masturbation on, 41, 72 

Genital apparatus, anatomy of, 28 

Glands, Bartholin's, 41 

— , Cowper's, 31 

Glans penis, anatomy of, 30 

— , changes in mucous covering 
caused by masturbation, 30 

Gland, prostate ; see Prostate 
Gland. 

Gleet, differentiation of discharge 
in, from seminal fluid, 49 

Grimaud de Caux on mental impo- 
tence, 89 

Gross on calculi beneath prepuce, 
160 

— on cartilaginous formations in 
corpora cavernosa, 159 

— on rupture of erectile tissue, 160 

— on spermatorrhoea, 61 

Gross, S. D., treatment of sperma- 
torrhoea and impotence, 269 

Gymnastic exercises causing mas- 
turbation, 65 



Ham, John, on spermatozoa, 44 
Hamilton, F. H., on the treatment 
of spermatorrhoea and impo- 
tence, 275 
Hammond on mental impotence, 
86 

— on satyriasis, 112 

Hands, condition of, in masturba- 
tion, 73-105 
Heart, hypertrophy of, from sexual 

excess, 100 
— , treatment of palpitation of, 244 
— , treatment of weakness of, 243 
Hemorrhage into the cerebellum, 

177 
Hensle on the bromides, 204 
Hippocrates on spermatorrhoea, 59 

— treatment of spermatorrhoea and 
impotence, 252 

Homoeopathic treatment of sper- 
matorrhoea and impotence, 250 

Humphrey on the treatment of 
spermatorrhoea and impotence, 
284 

Hutchinson, J, C, on the treat- 
ment of spermatorrhoea and im- 
potence, 279 

Hypertrophy of heart from sexual 
excess, 100 

Hygiene, sexual, ignorance of, 17 

Hypochondriasis, loi 

Hypospadias as a cause of sperma- 
torrhoea and impotence, 157 

Ignorance of sexual hygiene, 17 
Injections, astringent and anodyne, 

261 
Immorality in schools, 25 
Impotence, 58 
— , cause of, 62 

— , constitutional treatment of, 215 
— , diseases of the sexual organs 

associated with, 145 
— , first signs of, 79 

— from continence, 194 

— from excess, 79 

— from excess, prognosis in 
of, 80 

— , false, 91 

— from fear, 85 

— from fear, case of, 85 

— from mental emotions, 84 
— , local treatment of, 252 
— , mental, cases of, 86 et seq. 



^9^ 



INDEX. 



Impotence precedes spermator- 
rhoea, 79 

— in stallions caused by putting 
dorsal nerves of penis, 53 

Insanity as a result of abuse of 

sexual organs, 102 
Insomnia, treatment of, 73, 242 
Integument, changes in, in mastur- 
bation, 72 

— of penis, 33 

— of penis, effect of masturbation 
on, 33 

Intercourse, sexual, capacity for, 77 
— , sexual, frequency of, 77 
Irritable testicle, 130 
Irritability of neck of bladder, 135 

Jones on cerebral anaemia, 175 

KoBELT on erection of the penis, 55 
Kolliker on spermatozoa, 44 

— on the nerves of the penis, 34 

Labia majora, anatomy of, 40 
Lallemand's cauterization as a 
cause of sterility, 118 

— on continence, 186 

— on frequency of sexual inter- 
course, 77 

— on hypospadias, 157 

— on masturbation caused by cer- 
tain gymnastic exercises, 66 

— on persistent priapism, 178 

— on rectal troubles, 161 

— on spermatorrhoea, 60 

— on spermatorrhoea caused by 
phymosis, 148 

— on the condition of the ejacula- 
tory ducts in masturbation, 70 

— on tobacco as a cause of sper- 
matorrhoea, 167 

— method of examining for semen, 
74 

— porte caustique, 258 

Langer on the arteries of the penis, 

33 
Leaming on the cause of phthisis,* 

95 
Leucorrhoea, 64 
Lithotomy as a cause of impotence, 

157 
Local treatment of spermatorrhoea 

and impotence, 252 
Locomotor ataxia, 179 



MacDonald on sexual insanity, 

107 
McGraw on spermatorrhoea, 61 

— on the treatment of spermator- 
rhoea and impotence, 280 

Malformations of genitals, 157 
Marriage, age for, 184 

— as a cure for nymphomania, no 
Masturbating period. 63 
Masturbation a cause of epilepsy, 

96 
— , acne in, 73 
— , age at which it is commenced, 

63 
— , alimentary canal in, 73 

— as a cause of hypochondriasis, 
loi 

— as a cause of spermatorrhoea and 
impotence, 62 

— as a cause of varicocele, 122 

— as a result of varicocele, 124 

— as a vice of civilization, 62 

— caused by phymosis, 19 

— caused by certain gymnastic ex- 
ercises, 65 

— caused by warm or tight cloth- 
ing, 21 

— causing insanity, 102 

— , changes in the integument in, 

72 
— , characteristic face of, 67-73 
— , condition of hands in, 73 
— , condition of mind in, 73 
— , condition of muscles in, 73 
— , condition of penis in, 68 
— , condition of prostate gland in, 

71 
— , condition of scrotum in, 69 

— , condition of testicles in, 69 
— , condition of ejaculatory ducts 

in, 70 
— , condition of urethra in, 69 
— , condition of veru montanum in, 

69 
— , constitutional changes in, 72 
— , diseases arising from, 121 
— , diseases which arise from, 92 
— , effect of on ejaculatory ducts, 

32 
— , effect of on glans penis, 30 
— , effect of on integument of penis, 

33 
— , effect on offspring, 93 
— , eyes in, 73 



INDEX. 



297 



Masturbation, female organs con- 
cerned in, 39 
— , gait in, 73 
— , hypertrophy of heart from, 100 

— in female, effect of, on genera- 
tive organs, 41, 72 

— in nursing infants, 63 

— in the female, 40-41 

— ^Jess injurious to females than 

males, 67 
— , local effects of, 68 

— not confined to the human fam- 
ily, 62 

— , occupations predisposing to, 66 
— , posture in, 73 

— producing consumption directly, 

94 . . . ^ 

— producmg consumption in oflf- 

spring, 93 
— , prophylaxis of, 65 
— , seminal fluid in, 92 
— , signs of in early life, 64 
— , spermatozoa in, 92 
— , symptoms of, 208 et seq. 

— taught by nurses and domestics, 
64 

— , vertigo from, 100 
— , vertigo in, 73 

— vs. sexual excess, 77 
— , hands of, 105 

Maudsley on insanity produced by 

self-abuse, 103 
Mental emotions, 81 
— , impotence from, 84 
Mechanism of erection, 51 
Mental impotence, cases of, 86 
Mental influences as a cause of 

spermatorrhoea, 85 
Membranous portion of urethra, 31 
Mind, condition of in sexual ex- 
cesses and masturbation, 73 
Mons Veneris, anatomy of, 39 
Morals, school, 25 
Morgagni on hypospadias, 157 
Moschon on spermatorrhaea, 60 
Muscles, condition of, in mastur- 
bation, 73 

Narcotics, 167 

Neuralgia of neck of bladder, 134 
Nerves of the penis, 34 
Neuralgia of the testicles, 129 
Nocturnal emissions; see Emis- 
sions, nocturnal. 



" Non-Emission" of Acton, 117 
Nurses as teachers of masturbation, 

64 
Nutrition, depraved, 215 
Nux vomica in the treatment of 

spermatorrhoea and impotence, 

241 
Nymphomania, 108 

— produced by tumor of cerebel- 
lum, 51 

Obesity as a cause of sterility, ii8 

Occupations predisposing to mas- 
turbation, 66 

Offspring, effect of masturbation 
on, 93 

Onanism; see Masturbation. 

Orgasm, 53-78 

— , absence of, 116 

Palpitation of heart from sexual 
excess, 100 

— , treatment of, 244 

Par6 on spermatorrhoea, 60 

Parent's advice at puberty, 18 

Pathophobia, loi 

Penis, anatomy of, 29 

— , arteries of, 33 

— , condition of in masturbation, 
68 

— , congenital absence of, 159 

— , double, 160 

— , erector muscle of, 29 

— , integument of, 33 

— , nerves of, 34 

— , very large, 160 

— , very small, 159 

Perineum, 28 

Petroselinum sativum as an aphro- 
disiac, 247 

Phymosis, 145 

— as a cause of njasturbation, 19 
Phosphorus as an aphrodisiac, 246 

— in the treatment of spermator- 
rhoea and impotence, 241 

Phthisis; see Consumption. 
Physician's advice at puberty, 17, 

18 
Platonic attachments between boys, 

26 
Post, A. C, on the treatment of 

spermatorrhoea and impotence, 

278 
Posture in masturbation, 73 



298 



INDEX. 



Prepuce, the, 30 
Priapism, persistent, 178 
Prostate, chronic inflammation of, 

152 
— , congestion and inflammation 

of, 139 
— , anatomy of, 34 
— , condition of, in masturbation, 

71 

— , ducts from, 32 

— , examination of, 36 

— , function of, 35 

Prostatic calculi, 172 

Prostatitis, discharge in, differen- 
tiation of from seminal fluid, 50 

Prostatic portion of urethra, 32 

Puberty, advice of parent or guar- 
dian at, 18 

— , emissions before, 63 

— , physician's advice at, 17, 18 

Quack advertisements, 21 
Quinia in the treatment of sperma- 
torrhoea and impotence, 240 

Rectal pessaries in the treatment 
of spermatorrhoea and impotence, 
264 

Rectum, disorders of, 161 

Regimen in the treatment of sper- 
matorrhoea and impotence, 219 

Ritchie on insanity from self-abuse, 
103 

— on sexual insanity, 107 

— on suicide from masturbation, 
106 

Roland on a case of mental impo- 
tence, 86 
Romberg on irritable testicle, 131 
Rouget on erection of the penis, 56 

— on the arteries of the penis, 33 
Rufus, of Ephesus, on nocturnal 

emissions, etc., 60 

Saissaigne on abolition of the sex- 
ual passion, 52 
Sanguinaria as an aphrodisiac, 248 
Sartorius on spermatorrhoea, 60 
Satyriasis, in 

— produced by tumor of cerebel- 
lum, 51 

— treatment of, 115 
Sayre on phymosis, 147 
School morals, 25 



Sclerosis, 177 

Scrotum, amputation of, 127 

— , condition of in masturbation, 
69 

Sedatives in the treatment of sper- 
matorrhoea and impotence, 242 

Sensation in coitus in the female, 41 

Sensations terminating coitus, 32 

Semen, see Seminal Fluid. 

Seminal emissions, 74 

Seminal fluid, 43 

— , diagnosis of, 48 

— , differentiation from chylous 
urine, 50 
j — , differentiation of discharge in, 
I ■ from seminal fluid, 49 
j — , differentiation of, from dis- 
1 charge in cystitis, 50 

— , differentiation of from dis- 
charge in prostatitis, 50 

— , differentiation from that of 
Cowper's glands, 49 

— , differentiation of, from urethral 
secretion, 49 

— , in masturbators, 92 

— , involuntary discharge of, 58 

— , Lallemand's method of examin- 
ing for, 74 

— , quantity discharged during an 
emission, 47 

— , secretions mistaken for. 48 

Serrurieron epilepsy from mastur- 
bation, 98 

Sexual intercourse, capacity for. 77 

Sexual excess, diseases which ari.-e 
from, 92 

— , case of, 95 

— , diseases arising from. 121 

— , hypertrophy of heart from, ir o 

— not as injurious as self polluiioii, 
76 

— producing impotence, 79 
— , results of, 76 

— , vertigo from, 100 
Sexual functions, knowledge of, 17 
Sexual hygiene, ignorance of, 17 
Sexual indulgence, excessive, diag- 
nosis of, 32 
Sexual intercourse, frequency of, 77 
Sexual instinct, connection of the 

cerebellum with, 51, 52 
— , connection of the spinal cord 

with, 52 
— , location of, §l 



INDEX. 



299 



Sexual relations, husband and wife 
both ignorant of, 18 

Sleep in the treatment of sperma- 
torrhoea and impotence, 238 

Sleeplessness, see Insomnia. 

Sounds, introduction of in the treat- 
ment of spermatorrhoea and im- 
potence, 263 
^pasm of muscles connected with 
erection, 138 

Spermatic fluid, see Seminal Fluid. 

Spermatic veins, ligation of, 127 

Spermatorrhoea, 58 

— , local treatment of, 252 

— as the result of mental influ- 
ences, 85 

— , causes of, 62 

— , constitutional treatment of, 215 

— , diseases of the genital organs 

associated with, 145 
— , from stricture of rectum, 161 
Spermatozoa, 44 

— in masturbators, 92 
Spermatozemla, see Spermator- 
rhoea. 

Spinal cord, connection of with sex- 
ual instinct, 52 

Spitzka on sexual insanity, 108 

Sterility, 118 

Stillingia as an aphrodisiac, 248 

Stimulants in the treatment of sper- 
matorrhoea and impotence, 221 

Strieker on spermatozoa, 44 

Strychnia in the treatment of sper- 
matorrhoea and impotence, 240 

Suicide, 101-106 

Sunstroke, 181 

Testicle, irritable, 130 
Testicles, absence or atrophy of, 

160 
— , anatomy of, 37 
— , condition of in masturbation, 69 
— , neuralgia of the, 129 
Thompson, Sir H. on treatment of 

inflammation of prostate, 143 



Tight clothing, 21 

Tissues, erectile, 29 

Tobacco as a cause of spermator- 
rhoea and impotence, 167 

Tonics in the treatment of sper- 
matorrhoea and impotence, 239 

Treatment of spermatorrhoea and 
impotence, recapitulation of, 265 

Urethra, condition of in mastur- 
bation, 69 
— , female, anatomy of, 40 
— , membranous portion of, 31 
— , prostatic portion of, 32 
Urethral secretion, differentiation 

of, from seminal fluid, 49 
Urine, chylous, see Chylous Urine. 

Vagina, anatomy of. 41 
Van Buren on small penis, 159 
Van Buren and Keyes on asperma- 
tism, 117 

— on continence, 191 

— on irritable testicle, 131 

— on spermatorrhoea, 61 

— , treatment of spermatorrhoea 

and impotence, 272 
Vandeveer on spermatorrhoea, 61 
Varicocele as a cause of masturba- 
tion, 124 

— as a result of masturbation, 122 
— , treatment of, 125 

Vertigo in masturbation, 73 

— produced by sexual excess, 100 
— , treatment of, 244 

Veru montanum, 32, 53 
— , condition of in masturbation, 69 
Vesical catarrh, chronic, 156 
Vesiculse scminales, Acton on con- 
dition of, 45 
Vestibule, anatomy of, 40 

WiNSLOW on nymphomania, no 

Zimmerman on epilepsy produced 
by a seminal emission, 98 



SEXUAL NEURASTHENIA 

^^ BiB M^k. ^^ m^ ■■§ (NERVOUS EXHAUSTION.) 

Its Hygiene, Causes, Symptoms and Treatment, 

WITH A CHAPTER ON 

By Oeorge M. Beard^ A.M., M.D>, 

Formtxly Lecturer on Kervous Diseases in the University of the City of Newr York; 

fellow of the New York Academy of Medicine; Author of "On* 

Home Physician," *' Hay Fever;" one of the Authors of 

*' Medical and Surgical Electricity," etc. 

[posthumous manuscript.] 

Edited by A. D. Rockwell, A.M.. M.D. 

fWUovr of the New York Academy of Medicine, and Electro-Therapeutiit to tke 

N» Y. State Woman's Hospital; one of the Authors of ' Medical 

and Surgical Electricity," etc. 

The philosophy of this work is based on the theory that there is 
a special and very important and very frequent clinical variety of neuras- 
thenia (nervous exhaustion) to which the term sexual neurasthenia 
(seZUal exhaustion) may properly be applied. 

While this \ariety may be and often is involved as cause or effect 
©r coincident with other varieties — exhaustion of the brain, of the spine, 
of the stomach and digestive system — yet in its full development it can 
be and should be differentiated from hysteria, simple hypochondria, in- 
sanity, and various organic diseases of the nervous system, with all of 
which it had until lately been confounded. 

The long familiar local conditions of genital dehility in the malo 
— impotence and spermatorrhoea, prostatorrhoea, irritable prostate — 
which have hitherto been almost universally described as diseases by 
themselves, are philosophically jtnd clinically analyzed. These symp- 
toms, as such, do not usually exist alone, but are associated with other 
local or general symptoms of sexual neurasthenia herein described. 

ThO causes of sexual neurasthenia are not single or simple but 
complex; evil habits, excesses, tobacco, alcohol, worry and special ex- 
citements, even climate itself, are the great predisposing causes. 

The subject is restricted mainly to sexual exhaustion aS it CXistS in 
th© male, for the reason that the symptoms of neurasthenia, as it exists 
in females, are, and for a long time have been, understood and recog- 
nized. Cases analogous to those in females are dismissed as hypochon- 
driacs, just as females suffering from now clearly explained uterine and 
ovarian disorders were formerly dismissed as hysterics. 

This view of the relation of the reproductive System to nervous 
diseases is in accordance with facts that are verifiable and abundant ; 
that in men as in women, a large group of nervous symptoms, which are 
very common indeed, would not exist but for morbid states of the re- 
productive system. — [J^rom Dr. Beard's Introduction. 

The Causes and Symptoms of forty-three cases are given, fol- 
lowed by a chapter on treatment. — [-S"^^ Revieio of St. Louis Naiional 
Druggist and others. 

In One Volume. Crown 8vo, Neartu 300 pa^es. $2« 

IgADtS lantei E. B. TREAT, Pub., 771 Broadway, N. Y. 



50 Per Ct. Reduction. 1 -2 Price $1 2 for $6. 

"'OUR HOME: PHYSICIAN' has an established reputation for 
accuracy, learning and sagacity. 1 keep it on a prominent shelf in my 
library, and find it a kind of Guardian Angel of the household in matters 
sanitary and hygienic."— Rev. Joseph Cook. 

"'Our Home Physician' is, in our opinion, the best work 
upon the subject that has ever been published. It is full, from beginning 
to end, of intelligible, judicious and conscientious advice." 

—New York Medical Record. 

" It abounds In valuable hints and suggestions of a practical kind, which 
make it a valuable companion in the family. Dr. Beard has the genius 
and ability which fit a man to be an educator."—!.. J, Sanford, M.D,| 
Professor of Anatomy and Physiology in Yale College. 

"■ Space will not allow us to give even an outline of the vast and diversi- 
fied contents of this remarkable combination of all that laymen need to 
know. The book cannot fail to be useful wherever it goes." 

—New York Christian Advocats. 

" We do not hesitate to pronounce it a work of great value to every 

family in the land." —The Scientific AmeHcan (New York). 

" I take pleasure in offering you this expression of warm approval of it. 
I really admire the degree of intelligence, and fairness, and sound good 
sense exhibited throughout."— Samuel Hen'y DlckSOn, M.D., Profes- 
sor in the Jefferson Medical College, Philadelphia, Pa. 

"Whether for the rules of health or the emergencies of illness, this 
book is a comprehensive and trustworthy vade tnecutn. As a compend of 
the theory and practice of medicine, it is the best that we know." 

-New York Tribune. 

" I am glad so able a man as Dr. Beard has undertak'^n this work, and 
that he has performed his task so well. I take great pleasure in recom- 
mending the work as the best extant, and fully up to the times" — J, P, 
Ross, M.D., Professor in the Rush Medical College, Chicago, 111. 

" There is no ill that flesh is heir to that is not plainly described in its 
pages, and its appropriate treatment prescribed." 

-New Orleans Picayune. 

" Its general views on physiology and hygene are so sound, and it< 
directions what to do in emergencies so clear and concise, that I am convinced 
is will be found exceedingly useful by all." — J, L. CraWCOUr, M.D., 
Professor of Medicine, New Orleans School of Medicine. 

"Dr. Beard has been assisted in this work by a number of eminent 
men, and has succeeded in making a popular treatise on the science of 
medicine very far superior to any other in existence." 

—New York Evening Post, 
THIS WORK, 1506 pages, issued during a progress of two 
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